Insulin resistance ( insulin resistance) is a condition in which a normal way that gives the signal dropping biochemical messages between insulin and impaired target cells . As a result , the insulin does not use the normal effects or full . In other words , the body becomes resistant to the effects of insulin .
What does insulin normally ? Pancreas secrete varying amounts of insulin throughout the day in response to food . Insulin works to maintain blood sugar ( glucose ) at normal levels . Thus , insulin prevents the blood sugar becomes too high . If the insulin does not work this way , high blood sugar and diabetes will occur . Insulin is a hormone that acts on the receptors of the cells to trigger biochemical reactions that control blood sugar complex . Cells targeted by insulin is mainly fat cells ( adipocytes ) , muscle cells ( striated myocytes ) , and liver cells ( hepatocytes ) .
In insulin resistance , the damage to these receptors causes insulin to be less effective than it should be normally . So , the pancreas must produce more insulin than normal in order to maintain normal blood sugar levels . Initially in this process , insulin levels are increased sufficient to maintain normal blood blood . In these patients , however , despite normal blood sugar , the condition of being overweight or obese is fixed as indications that they are insulin resistance . At this point in time , only blood tests sophisticated ( such as euglycemic clamp test ) to detect insulin resistance at the level of biochemistry .
INSULIN RESISTANCE MECHANISM
KGD ‡ à ↑ ↑ ↑ ↑ Insulin Secretion
Blood insulin levels ↑ ↑
In the long term
INSULIN RESISTANCE Down à Regulation
Insulin resistance is a condition in which sensitivitasinsulin decreased . Insulin sensitivity of the hormone insulin lowers adalahkemampuan KGDdengan suppress hepatic glucose production danmenstimulasi skeletdan muscle glucose utilization in adipose tissue . The high KGD cause pancreatic cells to produce insulin continuously , karenabanyaknya kebutuhaninsulin then causes the pancreas cells no longer able to meet asupaninsulin ( threshold = 120mg/dl ) so terjadipenurunan menyebabkanresistensi insulin receptor insulin .
Criteria for Metabolic Syndrome
↑ levels of triglycerides ( > 150 mg / dl )
↓ HDL cholesterol levels ( L : < 40 mg / dl , P : < 50 mg / dl )
↑ blood pressure ( > 130/85 mmHg )
↑ GDP ( > 100 mg / dl )
Management of Acute Asthma Exacerbations
2-4 lpm nasal O2
Inf.RL 1500 cc/24 hours
Salbutamol sulfate 200 mg 2 sprays every 20 min in 1 hour
Terbutaline sulfate 250 mg 2 sprays every 20 min in 1 hour
Dexametashon inj 2 x 1 amp
Aminophilin injection 4 x 1 amp
GG 3 x 1 tab
criteria for Pneumonia
Shortness of breath accompanied nostril breathing and chest wall attraction
Moist rales were loud on the ” broncho pneumonia ” or bronchial voice : tone deaf
Chest x-ray : infiltrate the form of patches ( broncho ) , diffuse evenly / to one or several lobes
Indications and contraindications puncture of pleural fluid
1 . Therapeutic : Reduce shortness of breath
Pleural effusion , Hidropneumotoraks
2 . Diagnostic cytology , cultures of microorganisms ( resistance and sensitivity ) thd AFB , fungi and parasites
1 . Heart failure ( which is not yet resolved )
2 . Circumstances that can not tolerate a pneumothorax complications
3 . General condition is very weak that it can not sit / half-sitting
4 . The amount of liquid is too little
5 . Hemostasis disorders that have not been addressed
6 . Patients with positive pressure ventilation because of the risk of fistula and tension pneumothorax bronkhopleura
Skin infections are widespread in the lumbar region
Patients 45 years dg vommiting L , SGOT : 88 , SGPT : 99 .
Pmrx : sclera icterus , hepatomegaly , spider spiral .
Info required u / dx :
Vomiting BRP times ? Vomiting blood / – ? Since when icterus ? There acites / – ?
There palmar erythema / – ?
PMX cholestasis intra hepatal : inspection , palpation , percussion ,
Px that causes cholestasis intra hepatal :
Patients ( adults ) heat ± 4 days , myalgia , work in the fields à examination required ?
7 kinds of diagnostic tests
quickly for patients infected with the bacteria / parasites or viruses ?
Microscopic directly : Staining / painting specimen
Culture / Culture
Serology Test : Elisa Test
Molecular Dx : PCR ( polinuklear chain reactive ) , Hybridization of DNA – DNA or DNA – RNA for the detection of pathogen -specific genes from patient specimens .
Criteria Lupus nephritis
Proteinuria in ≥ 1 hour gram/24
Hematuria ( > 8 erythrocytes / LPB )
decline in renal function up to 30 %
Nephrotic syndrome criteria
Massive proteinuria ≥ 3.5 g / day
The initial symptoms / signs of early heart failure
Stable angina pectoris therapy not
Ny.W 60 years old, no history of LBP dg fall .
Physical Diagnostics : inspection , palpation , percussion ,
Tenderness ( + ) , Lasseque test ( + ) ,
Photos in need : photo lumbosacral AP , Lateral
Mefenamic acid 3 x 500 mg
Diclofenac Na 3 x 25 mg
Tn.D right leg joint pain , raised spots ( + ) redness in the face .
Physical Diagnostics :
Unlike Rheumatoid arthritis and SLE
Ket RA SLE
Erosive arthritis in nature nonerosif
DIC ( Disseminated Intravascular Coagulation ) :
Causes of DIC can be classified into acute or chronic , systemic or local and DIC can cause a single condition or multiple conditions .
In acute DIC , still depends on the cause of the DIC
o bacterium ( gram negative sepsis , gram-positive infections )
o Viral ( HIV , varicella , Hepatitis )
o fungal ( Histoplasma )
o Parasitic ( Malaria )
o Hematology ( myelositis acute leukemia )
o Metastatic ( mucin secreting adenocarcinoma )
o abruption palsenta
o amniotic fluid embolism
– Motor vehicle accident
– Toxicity of snake venom
– Hemolytic reaction
– T4ransfusi masiive
– Liver disease – hepatic failure acut
– Installation of prosthetic aids
– Tools ventricular function
In the chronic or subacute DIC encountered : thrombosis in thrombin formation and show signs and symptoms of venous tromboembolis .
o Signs of spontaneous bleeding or life-threatening
o Signs of bleeding subacut
o Signs of local or widespread thrombosis
– Central nervous system
o Decreased consciousness or stupor unspecific
o Decreased focal but infrequent / met
– Cardiovascular system
o Circulation collapse
– Respiratory System
o There Frictio Pleural rub
o Signs of ARDS
– Gastrointestinal System
– Genitourinary System
o Signs azotemia and renal failure
o Uterine Bleeding
– System Dermatology
o Bula hemorragie
o lower extremity skin necrosis ( fulminant purpura )
o Local infarction and gangrene
o Bleeding wounds and bleeding subkutanius in
There are two main causes of DIC are:
Systemic inflammatory response , leading to activation of cytokines induce activation of coagulation ( sepsis , major trauma ) .
Release or dissemination of material ( fat , phospholipids ) procoagulant intravenous ( cancer , cases of pregnancy )
In certain circumstances the second cause of the above may occur simultaneously as in the case of major trauma or severe necrotizing pancreatitis . There are several other conditions that can lead to DIC , namely :
Solid tumors and hematologic malignant
Obstetric kalaminis ( abruption placenta , fluid embolism omnion )
Other causes include severe toxicity or immunological reactions ( transfusion reactions ) or inflammatory reaction ( acut pancreatitis )