Please enable JavaScript.
Coggle requires JavaScript to display documents.
Penurunan Kesadaran, Ria Wenny Nasution 1908260021 SGD 7 - Coggle Diagram
Penurunan Kesadaran
-
-
Fisiologi Kesadaran
Pengaturan arousal dan tingkat kesadaran merupakan fungsi ARAS yang sifatnya menyeluruh (general). Neuron di ARAS bisa dirangsang oleh berbagai macam input sensori dari sistem somatosensori, auditori, visual serta sensori viseral. ARAS hanya melakukan fungsi pengaturan umum. Ketika ada stimulus baru, perhatian untuknya akan ditingkatkan dan kewaspadaan umum ditingkatkan. Kondisi ini tidak tergantung modalitas stimulus. Setelah sampai di talamus, stimulus baru diproyeksikan ke area khusus di korteks.
Fisiologi Jaras Motorik
raktus piramidal s. Traktus CorticospinalisMerupakan jaras motorik utama yang pusatnya di girusprecentralis (area 4 Broadmann), yang disebut juga korteks motorik primer. Impuls motorik dari pusat motorik disalurkan melalui traktus piramidal berakhir pada cornu aanterior medulla spinalis.
-
-
-
Patofisiologi
Intracellular growth of tachyzoites results in direct cytopathic effects, cellular inflammation, and necrosis. Type 1 cell-mediated immunity (CMI) is mainly required to control acute and chronic infection of T. gondii. Thus any defects in cell-mediated immunity predispose the host to develop severe manifestations of toxoplasmosis. In response to the damage caused by tachyzoite entry, the gut epithelial cells produce chemokines that act as chemical messengers resulting in the recruitment of dendritic cells (DC), macrophages, and neutrophils to the site of damage. The entry of tachyzoites into these inflammatory cells stimulates the production of interleukin-12 (IL-12). IL-12 induces interferon-gamma (IFN-gamma) synthesis by natural killer (NK) cells and T lymphocytes.
Cara Mendiagnosa
Serological testing - This is the primary diagnostic method to determine infection with Toxoplasma by identifying IgM and IgG antibodies. IgM antibodies are usually detectable from day 5 following infection, reaching maximum levels in 1 to 2 months. IgG antibodies are detectable after 1 to 2 weeks of infection, reaching maximum levels in 3 to 6 months. Toxoplasma IgM antibody testing lacks specificity; thus, serologies can be difficult to interpret.
Molecular testing - T. gondii DNA can be detected by polymerase chain reaction (PCR) in blood and other bodily fluids.
Radiological diagnosis - Computed tomography (CT) or magnetic resonance imaging (MRI) findings show multiple hypodense areas with ring-enhancing lesions in the brain. Minimal inflammatory changes seen during the early stages may not be appreciated well on CT; thus, MRI is preferred over CT for diagnosing brain lesions in cerebral toxoplasmosis. Single-photon emission CT or positron emission tomography (PET) scans have high specificity to rule out differential diagnoses.
Biopsy - Although this provides a definitive diagnosis by demonstrating tachyzoites and tissue cysts of T. gondii, this is not usually performed. A biopsy is indicated to rule out other differential diagnoses in individuals failing to show clinical or radiological improvement of symptoms within 14 days of starting the therapy.
Tatalaksana
The goal of treatment is to limit parasite multiplication during active infection. Therapeutic treatment is indicated in immunocompetent individuals with severe or prolonged symptoms as well as all immunocompromised patients. In cases of suspected T. gondii infection, empirical therapy based on presumptive diagnosis is preferred rather than waiting for test results. The combination of pyrimethamine (200mg loading dose followed by 50mg daily for patients <60kg and 75mg daily for patients >60kg) and sulfadiazine (1000mg four times a day for patients <60kg and 1500mg four times a day for patients >60kg) is the preferred regimen for treatment. Initial therapy should be continued for 6 weeks and be followed by chronic maintenance therapy.
Prognosis
Acute toxoplasmosis is typically self-limited in immunocompetent individuals. Prognosis is excellent without any long term effects of infection. Early diagnosis and initiation of empiric treatment, as well as antiretroviral therapy in patients with AIDS, improve outcomes in immunosuppressed individuals.
Edukasi
Cooking food to safe temperatures or freezing meats for several days at sub-zero temperatures prior to cooking
-
Thoroughly washing surfaces that have come in contact with raw meat, poultry, seafood, and unwashed fruits or vegetables
-
Wearing gloves and performing appropriate hand hygiene after contact with litter boxes and after contact with any sand or soil that may have been in contact with cat feces.
-