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Pemeriksaan Fisik dan Diagnostik Sistem Endokrin

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Pemeriksaan Fisik dan Diagnostik Sistem Endokrin Powered By Docstoc
					Tony Suharsono
Pemeriksaan Fisik
   A variety of disorders can be found
    within the endocrine system.

   Usually involves either too little or too
    much hormone activity
Health History
Physical Assessment
   Physical assessment starts with height,
    weight, and vital signs
   Inspection
     Observe the patient for mood and affect
     Inspect the neck for thyroid enlargement
      Look for eyes that bulge (exophthalmos)
     Note posture, body fat, and presence of tremor
     Observe skin and hair texture and moisture.
     Note the presence of a moonlike face or “buffalo
      hump” on the upper back.
     Observe the lower extremities for skin and color
      changes that might indicate circulatory impairment
Physical Assessment
 Palpation
 The thyroid gland
 Palpate all peripheral pulses.
 The posterior tibial and dorsalis pedis
  pulses may be diminished in patients
  with circulatory impairment.
 Palpate skin turgor
Physical Assessment
Diagnostic Testing
   Glucose Fasting Plasma
     Used to measure plasma glucose level after
      12 to 14 hour fast
     Purpose : to screen for DM, to monitor diet
      or drug therapy
     Patient Preparation : explain to the patient
      about the test, explain that the test requires
      a blood sample, instruct the patient to fast
      for 12-14 hour before test, alert the patient
      to the symtoms of hypoglicemia
Glucose Fasting Plasma
 Reference values : glucose value after
  fast at least 8 hours is 70-110 mg/dl atau
  3.9-6.1 mmol/L
 Abnormal findings
     Elevated : DM (required confirmation),
      pancreatitis, recent acute ilness (miocard
      infark)
     Low plasma glucose : hyperinsulinism
Glucose, 2 hour postprandial plasma

 Valuable screening tool for detecting DM
 The test is performed when the patient
  shows symtoms of diabetes or when the
  result of the fasting plasma glucose test
  suggest diabetes
 Purpose : to aid in the diagnosis of DM,
  to monitor drug or diet therapy in patient
  in DM
Glucose, 2 hour postprandial plasma
    Patient Preparation
      Explain to the patient that this test is used to
       evaluate glucose metabolism and to detect
       diebetes
      Explain that the test requires a blood sample
       and tell the patient when and where it will be
       taken
      Tell the patient to eat a balance meal or one
       containing 100 g of carbohydrate before the
       test and then to fast for 2 hours.
      Instruct him to avoid exercise after the meal
Glucose, 2 hour postprandial plasma

    Reference Value
      Less than 145 mg/dl or 8 mmol/L (in patients
       doesn’t have diabetes)
      Level slightly elevated in older than age 50
    Abnormal findings
      Value 200mg/dl or above indicate DM
      Hiperglicemia may also occur with
       pancreatitis, sindroma cushing
      Low glucose level occur in hyperinsulinism
Glucose tolerance test, oral
 The most sensitive method to evaluate
  borderline cases of diabetes
 Plasma and urine glucose level are
  monitored for 3 hours after the patient
  challenge dose of glucose
 Performed to assess insulin secretion and
  ability to metabolize glucose
 GTTO isn’t nosmally used in patient with
  fasting plasma glucose value >140mg/dl or
  post prandial plasma glucose value
  >200mg/dl
Glucose tolerance test, oral
   Purpose
     To confirm diagnosis of DM
     To aid in the diagnosis of hypoglicemia and malabsorbtion
        syndrome
   Patient Preparation
     Explain to the patient that the test is used to evaluate
        glucose metabolism
       Instruct the patient to maintain a high carbohydrate diet for
        3 days and then fast for 10-16 hours before test
       Tell the patient dont drink coffee or alcohol, or exercise 8
        hours before an during test
       Tell the patient that this test requires five blood sample
        and usually five urine samples
       Alert the patient to the symtoms of hypoglicemia
Glucose tolerance test, oral
   Reference values
     Normal plasma glucose level peak at 160-180
      mg/dl within 30 minute to 1 hour
     Return to fasting level or lower within 2-3 hours
     Urine glucose test remain negative
   Abnormal findings
     Decrease glucose tolerance, may confirm
      diabetes melitus
     Increase glucose tolerance, may indicate
      insulinoma
Hemoglobin glycosilated (HbA1c)
   Test is used to monitor doabetes therapy

   Provides information about the average
    blood glucose level during the
    preeceding 2-3 months

   It can be used to evaluate the long term
    effectiveness of diabetes therapy
Hemoglobin glycosilated (HbA1c)
 Purpose : to assess control of diabetes
  mellitus
 Patient Preparation
     Explain to the patient that this test is used to
      evaluate diabetes therapy
     Explain that the test requires a blood
      sample, and then tell the patient when and
      where it will be taken
     Inform the patient that he need not restrict
      food or fluids
Hemoglobin glycosilated (HbA1c)
   Reference value
     HbA1c values are reported as a percentage
      of the total Hb within RBC
     HbA1c account for 4 to 7%
   Abnormal findings
     Blood glucose good control regulation when
      the value <8%
     Value >10% indicates poor control
C Peptide
 Proinsulin is split into C-peptide and
  insulin. The level of C-peptide is
  considered equal to the amount of
  insulin
 Indicating the amount of insulin made by
  the pancreas
 The C-peptide test measures the level of
  C-peptide in blood and
 Is used to differentiate between types 1
  and 2 diabetes
C Peptide
 Purpose : C-peptide level in blood and
  differentiate between types 1 and 2
  diabetes
 Patient Preparation
     Why blood sample is taken
     That the patient should not eat or drink 8
      hours before the test is administered
     That the healthcare provider may ask the
      patient to stop taking alcohol, insulin,
      sulfonylureas for 2 weeks prior to the test
C Peptide
   Reference Values
     Normal C-peptide range: 0.78 to 1.89 ng/mL


     The blood glucose test is performed
     along with the C-peptide test and the
     results of both tests are compared.
C Peptide
   Abnormal findings
     High C-peptide and high blood glucose values
      may indicate : type 2 diabetes, insulin resistance
     High C-peptide and low blood glucose values
      may indicate: insulinoma, sulfonylureas
      consumtion
     Low C-peptide and low blood glucose values
      may indicate: lever disease, taken insulin
     Low C-peptide and high blood glucose values
      may indicate: type 1 diabetes, pancreatectomy
Others endocrin laboratory test
Nuclear Scanning
   A thyroid scan may be done to determine the
    presence of
   tumors or nodules.
   For this test, a radioactive material is injected or
    radioactive iodine is taken orally.
   After a specified time, the thyroid gland is scanned
    with a scintillation camera. The scan will show “hot
    spots,” which are nodules that are not malignant, or
    “cold spots” (areas that do not take up the
    radioactivity), which indicate malignancy. Cold spots
    can then be biopsied to confirm a diagnosis.
   The patient should be aware that the test takes
    approximately 30 minutes to complete.
Radiographic tests
   A computed tomographic (CT) scan or
    magnetic resonance imaging (MRI) may
    be done to locate a tumor or identify
    hypertrophy of a gland
Ultrasound
   Ultrasound may be done of the thyroid
    or parathyroid glands to determine if
    they are enlarged or to find masses
Biopsy
   Biopsy is done to obtain tissue to
    examine for possible cancerous cells.
    The thyroid gland can be biopsied either
    by needle aspiration under local
    anesthesia or using a surgical incision.

				
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posted:10/8/2011
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