case based discussion dr. anna
TRANSCRIPT
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 1/29
Case BasedDiscussion
ByAnnisa Rahim01.210.6082
Pembimbing:
dr. Hj. Nur Anna C. S., Sp.PD FINASIM
ILMU PENYAKI DALAM
UNI!E"SIAS ISLAM SULAN A#UN#$%&'
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 2/29
IDENTITAS PASIEN
Nama : Ny. E. S
enis !e"amin : Pe#em$uan
%mu# : &1 'h
A(ama : Is"am
Pe)e#*aan : Tida) Be)e#*a
A"ama' : Sido+ayah RT ,- R / Sido+ayah Reman(
No. C : 126.,.&/
Ruan( : B. I33ah 1- &11.,
Tan((a" asu) : /0 No4eme# 201,
Tan((a" !e"ua# : 6 Deseme# 201,
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 3/29
!E5%AN %TAA: nye#i $e#u'
RIA7AT PEN7A!IT SE!ARAN:
Pasien da'an( )e Po"i am)esmas RSISA den(an )e"uhan n(eri peru).
!e"uhan ini di#asa)an se*a) * + buan SRS. 5o)asi nye#inya di uu
-a)i, menjaar ampai /e /er0ng/0ngan sehin((a menyea)an
ea/ dan pana. N(eri -iang )imbu- 'e#u'ama ji/a paien
ma/an. Nye#i e#'amah *i)a $osisi $asien 'en()u#a$- dan e#)u#an(
*i)a 'idu# mi#in( )e )i#i. Pasien *u(a men(e"uh peru) /embung, )eraa
eba-, mua, mun)a-, )ida/ na1u ma/an., badan 2epa) ea- dan
ema/in /uru. 3AK maam -ari 4 5 6, eper)i )e-. & mingguan au 3A3 ber7arna -i)am.
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 4/29
RIA7AT PEN7A!IT DA%5%
Sa)i' se$e#'i ini 9;
Hiper)eni pada Ke-amian89
rauma 89, KLL, )rauma )-0ra6
3 89, peng0ba)an di "SUD "embang, din(a)a/an embu-
DM 89, /0n)r0 ru)in di "SUD "embang
#a)ri)i 89 e$a'i'is 9;
A"e#(i 9;
Penya)i' *an'un( 9;
Tumo#<Ca 9;
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 5/29
RIA7AT PEN7A!IT !E5%ARA
"i7a(a) Hiper)eni 89, A(a- Kandung
Ri+aya' D 9;
Ri+aya' a"e#(i 9;
Ri+aya' $enya)i' *an'un( 9;
Tumo#<Ca 9;
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 6/29
RIA7AT S=SIA5 E!=N=I
Pasien e#oa' den(an >asi"i'as !N PBI
Se"ama sa)i'- $asien hanya ma/an bubur umum 5 end0/ma/an, 56 e-ari.
Pasien sudah 'ida) e)e#*a
Pasien *a#an( me"a)u)an o"ah#a(a
Pasien 'ida) $e#nah me#o)o) mau$un men()onsumsi a")oho" danoa' 'e#"a#an(.
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 7/29
RIA7AT PEN=BATAN PEN7A!ITSE!ARAN
Berobat di RSUD Rembang
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 8/29
ANANESIS SISTEI!
%mum : 5emas 9?;
!u"i' : a'a" 9;- 5u)a di )a)i 9;- I)'e#i) 9;- $uca' 9;
!e$a"a : Nye#i !e$a"a 9?;- en*o"an 9;
a'a : $andan(an )au# 9;- ma'a me#ah 9;- ma'a)unin( 9?;
Te"in(a : an((uan $enden(a#an 9;- e#den(in( 9;-
se)#e' 9; idun( : mimisan 9;- se)#e' 9;
u"u' : sa#ia+an 9;- (usi e#da#ah 9;- ii# )e#in( 9?;
Ten((o#o)an : nye#i 'e"an 9;- sua#a se#a) 9;
5ehe# : 'e(an( 9;- )a)u9;- $emesa#an
)e"en*a# 9<;
Dada : a'u) 9;- daha) 9;- da#ah 9;- sesa) 9?;
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 9/29
Sis'em $ence#naan : na>su ma)an menu#un 9?;- mua" 9?;- mun'ah
9?;- )emun( 9?;- BAB 9; - nye#i $e#u' 9?;
Sis'em mus)u"os)e"e'a" : nye#i sendi 9;- nye#i $in((an( 9;
Sis'em sa#a> : nye#i )e$a"a 9?;
E)s'#emi'as : )esemu'an 9;- )a)u 9;-ce)o'ce)o'
9;-en()a) 9;
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 10/29
PEERI!SAAN @ISI!
Kesan Umum : Lemah
Kesadaran : Composmentis
Status Gizi : BB = 25 kg ; TB = 15 !m
B"# : BB $kg%&TB2 $m2% = 25 kg& $1'5 m%2
= 25&2'()
= 1* $under+eight%
,ita- Sign : T. = )*&/* mm0g
adi = / 3&menit
44 = 223&menit
S = /'*C
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 11/29
PEERI!SAAN @ISI!
!u"i' : +a#na sa+o ma'an(9?;- 'u#(o# ai)- i)'e#i) 9; !e$a"a : mesoce$ha" 5ehe# : sime'#is- $emesa#an )e"en*a# 9<;- de4iasi
'#a)ea 9;- P menin()a' 9; a'a : Con*un('i4a Anemis 9?<?;- S)"e#a I)'e#i) 9?<?; idun( : se)#e' 9;
Te"in(a : en'u) N- se)#e' 9;- (an((uan $enden(a#an9; Ten((o#o)an : nye#i 'e"an 9;- T1 T1- hi$e#emis 9; u"u' : ii# )e#in( 9?;- sianosis 9;- sa#ia+an 9;-
"idah )o'o# 9;
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 12/29
P@. T=RA PAR%INSPEKSI ANE"I;" P;SE"I;"
STATIS i$e#$i(men'asi 9;-s$ide# ne4i 9;- massa 9;-
#adan( 9;. emi'o#a)s)anan)i#i. ICS No#ma".
i$e#$i(men'asi 9;-s$ide# ne4i 9;- massa 9;-
#adan( 9;emi'o#a)s )anan)i#i..ICS No#ma"
DINAIS Pe#(e#a)an hemi'o#a)sde'#a
sinis'#aRR : 22<meni'
Pe#(e#a)an hemi'o#a)sde'#a
sinis'#aRR : 22<meni'
PA5PASI Nye#i 'e)an 9; - massa 9;S'em >#emi'us )anan)i#iICS me"ea# 9;
Nye#i 'e)an 9;- massa 9;S'em >#emi'us )anan)i#iICS me"ea# 9;
PER!%SI Sono# di se"u#uh "a$an($a#u de'#a dan sinis'#a
Sono# di se"u#uh "a$an($a#u de'#a dan sinis'#a
A%S!%5TASI Sua#a dasa# 4esi)u"e#-#on)i 9; Sua#a dasa# 4esi)u"e#-#on)i 9;
Ke
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 13/29
P@. ANT%N
Inpe/i : i)'us )o#dis 'e#"iha'
Papai : i)'us )o#dis 'e#aa di ICS "inea midc"a4icu"a#is sinis'#a
$u"sus $a#as'e#na" 9;- s'e#na" "i>' 9;- $u"sus e$i(as'#ium9;
Per/ui : #edu$
a'as a'as *an'un( : ICS II "inea s'#ena"is de'#a
$in((an( *an'un( : ICS III "inea $a#as'e#na" sinis'#a )anan *an'un( : ICS "inea s'e#na"is de'#a.
)i#i a+ah : ICS sinis'#a "inea midc"a4icu"a#is sinis'#a.
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 14/29
P@. ANT%N
Au/u)ai :
!a'u$ ao#'a : SD III mu#ni- #e(u"e#- AIFA2
!a'u$ '#i)us$id : SD III mu#ni- #e(u"e#- T1GT2
!a'u$ $u"mona": SD III mu#ni- #e(u"e#- P1FP2
!a'u$ mi'#a" : SD III mu#ni- #e(u"e#- 1G2
R : 8<meni'- #e(u"e#
Kean : N0rma
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 15/29
P@. ABD=EN
Inpe/i:
$e#u' ce)un(- si)a'#i) 9;- massa9;
Au/u)ai:
Bisin( usus 9?; H- isin($emu"uh da#ah 9;
Papainye#i 'e)an e$i(as'#ium 9?;.
Per/ui :
'im$ani se"u#uh "a$an( adomen
$e)a) sisi 9;- $e)a) a"ih 9;- undu"asi 9;
Hepar :
$e)a) 9?;
5i4e# s$an de'#a 8 cm- "i4e# s$an sinis'#a , cm
e$a'ome(a"i 9;
Lien :
'#oue s$ace $e#)usi 'im$ani
S$"enome(a"i 9;
Asci'es 9;- $e)a) a"ih 9;- $e)a) sisi 9;
Nye#i )e'o) cos'o4e#'e#a 9;
n(eri )e/an epiga)rium
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 16/29
P@. E!STREITAS
E/)remi)a Superi0r In1eri0r
=edem < <
A)#a" din(in < <
Ree) Jsio"o(is ?<? ?<?
Ree)$a'o"o(is < <
!e)ua'an o'o' ,<, ,<,
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 17/29
PEMERIKSAAN LABORATORIUM
HEMATOLOGI Hasil Ket
Darah Rutin
Hemoglobin !"# g$dl L
Hemato%trit &"' ( L
Leu%o)it *"+ ribu$uL
Trombo)it &' ribu$uL L
,olongan Darah A$Po)iti-
KIMIA HasilUreum +& mg$dl
.reatinin !"*/ mg$dl
S,OT /0 U$I
S,PT /* U$I
HbA1 +"0(
Am2la)e '& U$I
Li3a)e + U$IIMUNOSEROLOGI Hasil Keterangan
HB)Ag Kualitati- Non Rea%ti-
Anemia" trombo)ito3enia" hi3eruremia
KIMIA Hasil
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 18/29
HEMATOLOGI Hasil Ket
Darah Rutin
Hemoglobin &"4 g$dl L
Hemato%trit "0 ( L
Leu%o)it "& ribu$uL H
Trombo)it '* ribu$uL L
KIMIA Hasil
,DS '!
Ureum /+ mg$dl
.hole)terol !+
.reatinin !"+0 mg$dl
S,OT *0 U$I
S,PT #+ U$I
Bilirubin Total /"*+
Bilirubin Dire1t "#*
Bilirubin Indire1t "'
Total Protein +"!+
Albumin "*#
,lobulin &"#
Natrium &#"#
Kalium #"4
KIMIA Hasil Keterangan
T, #/
HDL / L
LDL 0/
Uri1 A1id +"
.hloride !+"& H
.al1ium 0"* L
Magne)ium "+ L
Anemia" leu%o)ito)i)" trombo)ito3enia" hi3er%loremia" hi3o%al)emia" hi3omagne)
hi3ergli%emia" hi3o3roteinemia" hi3oalbumin" hi3onatremia
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 19/29
Irama : inu"-()me: #e(
Fre/ueni: 1<meni'
#e0mbang 0-12 s
In)er<a P" K0mpe/ >A6i = "ead I
?0na )rani
c"oc)+iseSegmen S #e0mbang
Kean : Sinu
a5L
LI
a5R
LII
a56
LIII
5
5/
5&
5#
5+
5*
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 20/29
US, Abdomen
Ke)an7
,a)triti)
He3ar ta%
e%ogenita)
mening%at
DD$ 6att2
5e)i%a -ele
%iri$3an%re
$8e)i%a uriditemu%an
Ta% tam3a
3leura
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 21/29
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 22/29
.T S.AN Abdomen
Pada regio antrum:32loru) tam3a% 3enebala
lobulated" te3i regular ;.T number 3re %on
2ang men2ebab%an 3en2em3itan lumen 3ar
%ontra) tam3a% enhan1ement inhomogen ;.
%ontra) &*:0& HU< 1uriga ma))a
Tam3a% 3elebaran du%tu) 3an%reati%u) ;>
)tru%tur hi3oden) ;.T number 0!:4! HU ? de
di)e%itarn2a dan ta% tam3a% )tru%gtur 3are
3an%rea)
1enderung gambaran 6att2 Re3Pan1rea)
Kal)i-i%a)i 3ada du%tu) 3an%reati%u) dan )e
3an%rea)
He3ar$8e)i%a -ellea$lien$gin9al %anan:
%iri$aorta$3araaorta$8e)i%a urinaria$uteru)
ta% ditemu%an %elainan
A)1ite)
Ta% tam3a% e--u)i 3leura
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 23/29
DATA ABN=RA5
Anamnesis
• N2eri ulu hati• / Se)a%• & Kerong%ongan 3ana)• # Perut %embung" )ebah• + Mual• * Muntah• 0 Tida% na-)u ma%an• 4 .e3at lelah• ' Sema%in %uru)• ! BAK malam @ &"• arna urin )e3erti teh• / BAB Carna hitam• & RiCa2at hi3erten)i 3ada
%ehamilan"• # RiCa2at TB• + RiCa2at DM• * RiCa2at ga)triti)
Peme#i)saan @isi)
• 0 UnderCeight• 4 Hi3oten)i• ' .on9ungti8a anemi)• /! Bibir %ering
• / Abdomen7 n2eri te%ane3iga)trium
Peme#i)saan Penun*an(
• LA3;"A;"IUM• // Anemia• /& Trombo)ito3enia• /# Hi3eruremia• /+ Hi3o%al)emia"• /* hi3omagne)emia"• /0 hi3ergli%emia"• /4 hi3o3roteinemia"• /' hi3oalbumin "
• &! hi3onatremia• & HbA1 ri)i%o tinggi DM
• 32 EKG7 Sinu) Ta%i%ardi
• 33 USG7 ga)triti)" e%ogenita) 3aren%imening%at homogen" DD7 -att2 li8er" %roni)
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 24/29
&# .T S1an Abdomen7
Pada regio antrum:32loru) tam3a% 3enebalan )imetri)" lobulated" te3i regularcuriga massa
3elebaran du%tu) 3an%reati%u) cenderung gambaran att! Re"lacement#$ t%e &ancreas
Kalsi$i'asi "ada du'tus "an'reati'us dan sebagian stru'tur "an'reas
a)1ite)
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 25/29
PR=B5E 5IST
&. um0r Pan/rea9"/"&"#"+"*"0"4"'"!""/"0"4"'"/!"/"//"/&"/#"/+"/*"/
0"/4"/'" &!" &&"&#< $. #a)ri)i 8" #" +" *" 0" *"/" &&<
5. Diabe)e Mei)u ipe $ 84"'" !"+"0"/0"&<
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 26/29
TUMOR &ANKREAS
Ass : Tumor Pankreas, Pankreatitis, Hepatitis
IpDx : laboratorium (darah rutin, amilase, lipase, glukosa, SGOT, SGPT, LDH, !P,
bilirubin"# $SG abdomen, T s%an abdomen, &!P'
IpTx :
armakologik :
)or*in Sul*at + x + mg
-it' + x .mg
/on *armakologik : pembedahan (konsul dr' Sp0"
IpMx : keadaan umum, tanda1tanda -ital
IpEx : istirahat, tidur bantal tinggi, mengurangi akti-itas berat
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 27/29
GASTRITIS
Ass : Gastritis, $lkus Gaster
IpDx : laboratorium (darah rutin, endoskopi, $SG abdomen"
IpTx :
armakologik :
Lansopra2ol 3 x 4 mg
non *armakologik: diet rendah lemak, serat halus, dan rendah garamIpMx : keadaan umum, tanda1tanda -ital, ge5ala1ge5ala dispepsia
IpEx : hindari makanan 6ang mengandung bahan 6ang merangsang,
menimbulkan gas, dan bersi*at asam'
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 28/29
DIA3EES MELLIUS IPE $
Ass : D) tipe 3, D) tipe +
IpDx : GDP, GD3PP, Hb7+%, TTGO
IpTx:
armakologi : Insulin 4 x . unit
non*armakologi : kebutuhan makanan +3 kalori8hari
diet rendah gula
latihan 5asmani IpMx : 9eadaan umum, GDS
IpEx : mengatur pola makan sesuai dengan prinsip 4
olahraga rutin, minimal 4xseminggu, durasi 4 menit
kontrol dan minum obat teratur
7/23/2019 Case Based Discussion Dr. Anna
http://slidepdf.com/reader/full/case-based-discussion-dr-anna 29/29
E"IMAKASIH