tuberculosis arthritis

8/12/2019 Tuberculosis Arthritis

1/15

Summary of Data Base

Mrs S/46 y o/W28Chief complaint: Right knee pain

Patient suffered from pain in the right knee since 1

year ago, especially when she walked and walked up

stair. It worsened since 2 months ago and makeslimitation of activity. It was accompanied with swelling on

the right knee, inflammed but no pain when pressed, leg

edema was negative.

History of trauma was denied. There were no

cracking sensation on morning stiffness. She didnt take

any analgetic.

She didnt complained about fever and cough.

Urination normal, defecation normal. Nausea, vomit, and

headache was denied.


2/15

SUMMARY OF DATA BASE

History of past illness : 1 year ago she underwent joint fluid aspiration in RSSA

because of same complain

Hypertension since 15 years ago, no routine control, and

blood pressure is around 150/- History of DM was denied

History of social living : She had 3 children, worked as

factory labour. Her husband passed away 1 year ago

because renal failure, drunk traditional potion, analgeticand alcohol was denied


3/15

Physical examinationWard BP: 170/100mmHg Ward PR: 90 bpm

regular strong

Ward RR: 20 tpm Ward Tax: 36,8C

General appearance looked ly moderately ill Ward GCS: 456 Looked overweight

BW: 70 BMI: 28.4

Head Within normal limit Within normal limit

Neck Within normal limit

Chest Heart: Ictus invisible and palpable at ICS V 2 cm lat MCL S

LHM ictus RHM: SL D

S1, S2 single, murmur ( - )

Lung: Within normal limit

Abdomen Within normal limit

Extremities Acral warm, leg edema -/-

Genu D swelling (+), pain (+), crepitation (-), mass (-)


4/15

LAB VALUE (NORMAL) LAB VALUE (NORMAL)

Hb 12.2 11,0-16,5 g/dL Ureum 23.80 10-50 mg/dL

MCV 78.60 80-96 fl Creatinine 0.95 0,7-1,5 mg/dL

MCH 24.90 26,5-33,5 pg Kolesterol Total 111 50mg/dL

3.1 / 0.1 / 78.6/13.6 / 4.6 % Kolestrol LDL 98


5/15


6/15

ECG

Sinus rhythm, heart rate 88 bpm Frontal Axis : N

Horizontal Axis : CWR

PR interval : 0,12

QRS complex : 0,08

QT interval : 0,36

Conclusion : Sinus rhythm HR 88 bpm


7/15


8/15

Alignment: Good

Bone: fracture (-)

Joint: dislocation (-) Soft tissue: Looks swelling, radiolusent

appearence

Conclusion: Soft tissue swelling, gangrenegas

Genu R AP/Lateral


9/15

CUE AND CLUE PL IDx PDx PTx PMo

Female / 46 yo

A

Genu D pain since 1

years ago

limitation of activityHistory sinovial fluid

aspiration

PE:

BW:76 BMI: 28.4

Swelling at genu D

Warm

pain (+)

Genu AP/Lat : Soft

tissue swelling

1. Chronic

monoarthrit

is genu

dextra

1.1 Tuberculosis

arthritis

1.2 Septic

arthritis

synovial

fluid culture

analysis ,

AFB

IV Plug

Inj. Ceftriaxon 2x1

PO: Parasetamol 3x500

mg

S, VS

Female / 46 yo

A

History of HT for 15

years

PE

BP 170/100

2.

Hypertensio

n st II

3.1 secondary

3.1.1

3.1.2

3.2

Funduscopy PO: captopril 3x25 mg S, VS


10/15

CUE AND CLUE PL IDx PDx PTx PMo

Female / 46 yo

A

limitation of activity

History sinovial fluid

aspirationPE:

BW:76 BMI: 28.4

Swelling at genu D

Crepitation bilateral

genu (+)

3. OA genu

bilateral


11/15

Tuberculosa arthritis Septic Arthritis

Hypertension

PROBLEM ANALYSIS

OA?


12/15

Risk Factors

Artificial joint implants Existing joint problems(osteoarthritis, gout,

rheumatoid arthritis,or lupus)

Bacterial infection somewhere in your body

Cronic illness or disease (DM, RA, Sickle cell disease)

Intravenous or injection drug use

Medication that suppresed imune system

Recent joint injury

Recent joint arthroscopy or other surgery

Skin fragility


13/15

Management analysis

Emergency: -

Urgency: -

Non Urgency:

Septic arthritisInj. Ceftriaxon 2x1

PO: Parasetamol 3x500 mg


14/15

Condition this morning

BP: 160/100

PR: 88RR: 18

Tax: 36.8


15/15

Thank you

tuberculosis arthritis

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