sirosis hepatis .docx

7/24/2019 Sirosis Hepatis .docx

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BAGIAN ILMU PENYAKIT DALAM LAPORAN KASUS

FAKULTAS KEDOKTERAN Januari 2015

UNIVERSITAS HASANUDDIN

SIROSIS HEPATIS

OLEH :

Sri a!"uni R#

$111 11 %&'

PEMBIMBING :

(r# L)*nar( Ka+*,i

PEMBIMBING BACA :

(r# A-!"ar A,.aar

DIBAAKAN DALAM RANGKA KEPANITERAAN KLINIK

BAGIAN ILMU PENYAKIT DALAM FAKULTAS KEDOKTERAN

UNIVERSITAS HASANUDDIN

MAKASSAR

2015

1


2/36

LEMBAR PENGESAHAN

Yan/ .)ran(a an/an (i .aa! ini +)n"aa-an .a!a 3

Na+a 3 Sri a!"uni R#

NIM 3 $111 11 %&'

Uni4)ria 3 Haanu((in

Ju(u, 3 Sir*i H)6ai

),a! +)n"),)ai-an ,a6*ran -au ()n/an 7u(u, )r).u (a,a+ ran/-a

-)6ani)raan -,ini- 6a(a .a/ian I,+u P)n"a-i Da,a+ Fa-u,a

K)(*-)ran Uni4)ria Haanu((in#

Ma-aar Januari 2015

P)+.i+.in/ $*a

dr. Leonard Kamoli Sri Wah!ni R.

P)+.i+.in/ Ba8a

dr. A"har Al#aar

2


3/36

BAGIAN ILMU PENYAKIT DALAMFAKULTAS KEDOKTERANUNIVERSITAS HASANUDDIN

CATATAN RIWA$AT PEN$AKIT

Na+a P)n()ria 3 Tn# SJ)ni K),a+in 3 La-i9,a-iT/, ,a!ir 3 &9591&'5A,a+a 3 Bau9.auN*# R)-a+ M)(i 3 :&2;&5Tan//a, P)+)ri-aan 3 119129201;

D*-)r +u(a 3 Sri a!"uni R#

I. SUB%EKTI&

a.Anamnesis :Au*ana+n)i

b.Keluhan Utama : P)ru +)+.)ar

c.Anamnesis Terpimpin :

- P)ru +)+.)ar (ia,a+i )7a- 2 +in//u ).),u+ +au- ru+a! a-i

(iraa-an +)+.)ar 6)r,a!an9,a!an i(a- a(a n")ri 6)ru 8),ana

)raa +)n")+6i (an 6)ru )raa 6)nu!# Mua, (an +una! i(a- a(a

na+un ria"a +una! (ara! a(a 2 +in//u "an/ ,a,u ()n/an 4*,u+)

)-iar 500 88# Naaa+

+)


4/36

Ria"a +)r*-*- a(a )7a- 5 a!un "an/ ,a,u )a6i .)r!)ni )7a-

+au- ru+a! a-i aa +au (i*6)rai !)rnia = +in//u "an/ ,a,u

Riwayat penyakit sebelumnya :

- Ria"a +)n()ria 6)n"a-i -unin/ >@? )7a- 12 a!un "an/ ,a,u

- Ria"a !i6)r)ni >9?

- Ria"a DM >9?

Riwayat pribadi dan keluarga :

- Ria"a +)r*-*- >@? )7a- 5 a!un "an/ ,a,u )a6i .)r!)ni )7a-

+au- ru+a! a-i aa +au (i*6)rai !)rnia = +in//u "an/ ,a,u

-Ria"a +inu+ a,-*!*, i(a- a(a

II. OB%EKTI&

' S(a(!) Pa)ien :

- Sa-i )(an//ii 8u-u68*+6*+)ni

- BB 3 55 -/

- TB 3 1:5 8+

- IMT 3 551,652 C 2022 -/+2>N*r+a,?

' Tanda *i(al :

- T)-anan (ara! 3120'0 ++H/ r)/u,)r -ua an/-a#

- Na(i 3 %% +)ni

- P)rna6aan 3 22+)ni

- Su!u 3 =:5*$

' Pemeri")aan &i)i" :

Ke+ala

- E-6r)i 3 Biaa- Si+)ri +u-a 3 Si+)ri -iri (an -anan- D)


5/36

Ma(a

- E-*6a,+uEn*6a,+u 3 >9?- G)ra-an 3 Da,a+ .aa n*r+a,- T)-anan .*,a +aa 3 Da,a+ .aa n*r+a,

-K),*6a- +aa 3 E()+a 6a,6).ra, >9?

- K*n7un/i4a 3 An)+i >@@?- S-,)ra 3 I-)ru >@@?- K*rn)a 3 J)rni!- Pu6i, 3 Bu,a i*-*r

25++25++

Telin,a

- T*6!i 3 >9?- P)n()n/aran 3 Da,a+ .aa n*r+a,

-N")ri )-an (i 6r*)u +a*i()u 3 >9?

Hid!n,

- P)r(ara!an 3 >9?- S)-r) 3 >9?

M!l!(

- Bi.ir 3 Pu8a >9? K)rin/ >9?- Gi/i /),i/i 3 $ari) >9?

-Gui 3 P)r(ara!an /ui >9?

- T*ni, 3 T1 T1 !i6)r)+i >9?- Farin/ 3 Hi6)r)+i >9?- Li(a! 3 K**r >9? r)+*r >9? !i6)r)+i>9?

Leher

- K),)n7ar /)a! .)nin/ 3 Ti(a- a(a 6)+.)aran- K),)n7ar /*n(*- 3 Ti(a- a(a 6)+.)aran- DVS 3 R 92 8+H2O- P)+.u,u! (ara! 3 Da,a+ .aa n*r+a,

-Ka-u -u(u- 3 Ti(a- a(a >9?

- Tu+*r 3 Ti(a- a(a >9?

Thora")

In6)-i

- B)nu- 3 N*r+*8!) i+)ri -iri (an

-anan- P)+.u,u! (ara! 3 S6i()r n)4i >9?- Bua! (a(a 3 Gin)-*+aia >@?

-S),a i/a 3 Da,a+ .aa n*r+a,

5


6/36

- Lain9,ain 3 Ti(a- a(a >9?P!n,,!n,

Pa,6ai 3 N")ri )-an >9? Maa u+*r >9?

N")ri -)*- 3 Ti(a- a(a >9?

Au-u,ai 3 Bun"i 6)rna6aan3 V)i-u,)r

R*n8!i 99 !))in/ 99

G)ra-an 3 Da,a+ .aa n*r+a,

Par!

Pa,6ai

- Fr)+iu ra.a 3 Si+)ri -iri (an -anan#-

N")ri )-an 3 Ti(a- a(a P)r-ui

- Paru -iri 3 S*n*r - Paru -anan 3 S*n*r - Baa 6aru9!)6ar 3 I$S VI ()-ra an)ri*r- Baa 6aru .),a-an/ -anan3 )in//i 8*,u+na

4)r).ra !*ra-a, I ()-ra- Baa 6aru .),a-an/ -iri3 )in//i 8*,u+na 4)r).ra

!*ra-a, inira

Au-u,ai

- Bun"i 6)rna6aan 3 V)i-u,)r

- Bun"i a+.a!an 3 R*n8!i 99 !))in/ 99

%an(!n,

In6)-i 3 I8u 8*r(i i(a- a+6a-

Pa,6ai 3 I8u 8*r(i i(a- )ra.a

P)r-ui 3 P)-a- .aa 7anun/ -)an n*r+a, >.aa

7anun/ -anan (i ,in)a 6ara)rna,i ()ra .aa 7anun/

-iri (i ,in)a +i(8,a4i8u,ari inira I$S V .aa 7anun/

aa I$S II?

6


7/36

Au-u,ai 3 Bun"i 7anun/ III +urni r)/u,ar .un"i

a+.a!an >9?

A#domen

In6)-i 3 $)+.un/ i-u /)ra- na6a (in(in/ a.(*+)n

na+6a- (i)n()( -*,a)ra,iai 4)na >@?

Au-u,ai 3 P)ria,i- >@? -)an n*r+a,

Pa,6ai 3 N")ri )-an >9? +aa u+*r >9?

H)6ar i(a- )ra.a Li)n )ra.a 8!u@?

Ala( Kelamin

Ar*6!i )i >@?

An!) dan Re"(!m

H)+*r*i( >@? 6!in8)r ani +)n8)-i- +u-*a ,i8in

6)+.)aran 6r*a >9? +aa u+*r >9? a+6u,a .)rii 9? ,)n(ir >9?#

E")(remi(a)

Su6)ri*r 3 A-ra, !an/a )ri)+a 6a,+ari >@?

E()+a 3 E()+a >@? 6a(a 6)(i (an 6r)i.ia, ()ra )

inira

La#ora(ori!m

%ENIS

PEMERIKAANHASIL NILAI RU%UKAN

-ARAH

RUTIN

B$ 2% 10=uL ; 9 10 10=uL

RB$ 2;; 10:uL ;: 10:uL

HGB % /(L 12 9 1: /(L

H$T 2=: =' ;%

M$V &:


8/36

M$H$ ==' /(, =2 9 =: /(,

PLT 10010=uL 150 9 ;00 10=uL

NEUT ;=% 52#0 9 '50

LYMP

H =05 200 ;00

MONO 1&= 200 %00

EOS ;' 100 =00

BASO 1' 000 010

%ENIS PEMERIKSAAN HASILNILAI

RU%UKAN

&AAL

HEMOSTATIS

Ur)u+ 1: +/(L 10950 +/(L

Kr)ainin 0: +/(L 11 +/(L

SGOT :1 UL =5 UL

SGPT ;0 UL ;5 UL

H.A/ R)a8i4) N*n r)a8i4)

Ani H$V N*n r)a8i4) N*n r)a8i4)

Pr*)in T*a, 5% /(, :: 9 %' /r(L

A,.u+in 1% /r(, =5 9 50 /r(L

Bi,iru.in *a, 1'5 +/ 11 +/

Bi,iru.in (ir)- 0%; +/ 02 +/

PT 1:% 8*nr*, &: 10 1;

INR 1='APTT 50= 8*nr*, 2' 220 =00

ELEKTROLIT

-ARAH

Nariu+ 1=5 ++*,L1=:91;5

++*,L

Ka,iu+ 2& ++*,L=#595#1

++*,L

K,*ri(a 10'&'9111

++*,L

%ENIS PEMERIKAAN HASIL NILAI RU%UKAN

URIN

RUTIN

arna Kunin/ Kunin/ +u(a

6H :5 ;5 %0

Pr*)in N)/ai< N)/ai<

G,u8*) N)/ai< N)/ai<

Bi,iru.in N)/ai< N)/ai<

Ur*.i,in*/)

n

N*r+a, N)/ai


9/36

Niri N)/ai< N)/ai<

Dara! N)/ai< N)/ai<

L)-*i N)/ai< N)/ai<

Vi $ N)/ai< N)/ai<

S)(i+)n

,)-*i

2 5

S)(i+)n

)rir*i

1 5

S)(i+)n

*ra-

9 9

S)(i+)n

Kria,

9 9

S)(i+)n)6i), ),

9 9

Ha)il USG A#domen :

o Sir*i !)6ai

o S6,)n*+)/a,"

o A8i)

Ha)il Endo)"o+i:

o Vari) )*


10/36

- In


11/36

+)@? )7a-

5 a!un "an/ ,a,u )a6i .)r!)ni )7a-

+au- ru+a! a-i aa +au (i*6)rai

!)rnia = +in//u "an/ ,a,u

O 3 SSG$$M

TD 3 110'0 ++H/

N 3 %; +)ni P 3 20 +)ni

S 3 =' $

An >@? I- >@?

DVS R92 8+H2O

BP 3 V)i-u,)r BT 3 R! 99 ! 99

BJ 3 III +urni r)/u,ar BT >9?

A.( 3 P)ria,i- >@? -)an n*r+a,

H)6ar i(a- )ra.a ,i)n )ra.a

8!u@?

E- 3 E()+a >@@? 6a(a 6)(i (an

6r)i.ia,

A 3

Sir*i H)6ai D)8*+6)naa )#8#

H)6aii Viru B -r*ni-

P* H)+a)+)i M),)na )#8#

Su6)8 Vari8)a, B,))(in/

A8i) /ra() III )#8# Sir*i

H)6ai D)8*+6)naa

Hi6*a,.u+in)+ia

Pani*6)nia -aua

Hi6)r6,)ni+)

7a+*ra,

Tran


12/36

n")ri 6)ru >9? na9? +una! >9?# Ria"a +una! (ara! 2

+in//u "an/ ,a,u ()n/an 4*,u+) )-iar

500 88# A(a n")ri 6a(a anu aa BAB

ria"a BAB )n8)r arna !ia+ 2 +in//u

"an/ ,a,u ),a+a 2 !ari# Ria"a a-i

-unin/ >@? 12 a!un "an/ ,a,u# Ria"a

(ia.)) (an !i6)r)ni i(a- a(a#

Ria"a +inu+ a,-*!*, >9?# Ria"a

+)r*-*- >@? )7a- 5 a!un "an/ ,a,u )a6i

.)r!)ni )7a- +au- ru+a! a-i aa

+au (i*6)rai !)rnia = +in//u "an/ ,a,u

O 3 SSG$$M

TD 3 120&0 ++H/

N 3 %; +)ni

P 3 1% +)ni

S 3 =:' $

An >@? I- >@?

DVS R92 8+H2O

BP 3 V)i-u,)r BT 3 R! 99 ! 99


A.( 3 P)ria,i- >@? -)an n*r+a,


8!u@? E- 3 E()+a >@@? 6a(a 6)(i (an

6r)i.ia,

A 3



P* H)+a)+)i M),)na )#8#



))+)ni

Fur*)+i( ;0 +/2;

7a+*ra,

S6ir*n*,a8*n) 100+/2; 7a+*ra,

Pr*6an*,*, 10 +/%

7a+*ra,

BRM 1 -a6u,% 7a+*ra,

AHF$ 1 a8!)% 7a+*ra,

Tran


13/36

H)6ai D)8*+6)naa

Hi6*a,.u+in)+ia

Pani*6)nia -aua

Hi6)r6,)ni+)1;12201

;

P)raaan !ari9=

S 3 P)ru +)+.)ar 6)ru )raa 6)nu!


+in//u "an/ ,a,au ()n/an 4*,u+) )-iar

500 88# BAB -uran/ ,an8ar )+in//u 2

-a,i ()n/an -*ni)ni 6a(a a(a n")ri

6a(a anu aa BAB ria"a BAB )n8)r

arna !ia+ 2 +in//u "an/ ,a,u ),a+a 2

!ari# Ria"a a-i -unin/ >@? 12 a!un

"an/ ,a,u# Pai)n 7u/a .iaan"a

+)n/-*nu+i *.a ana,/)i- >aa+

+)@? )7a- 5

a!un "an/ ,a,u )a6i .)r!)ni )7a-

+au- ru+a! a-i aa +au (i*6)rai

!)rnia = +in//u "an/ ,a,u

O 3 SSG$$M

TD 3 110:0 ++H/

N 3 %% +)ni

P 3 20 +)ni

S 3 =:% $

An >@? I- >@?

DVS R92 8+H2O

BP 3 V)i-u,)r BT 3 R! 99 ! 99


P 3

Di) H)6ar II

In


14/36

A.( 3 P)ria,i- >@? -)an n*r+a,


8!u@?

E- 3 E()+a >@@? 6a(a 6)(i (an

6r)i.ia,

A 3



P* H)+a)+)i M),)na )#8#

Su6)8 Vari8)a, B,))(in/ A8i) /ra() III )#8# Sir*i

H)6ai D)8*+6)naa

Hi6*a,.u+in)+ia

Pani*6)nia -aua

Hi6)r6,)ni+)

1512201

;

P)raaan !ari9;



+in//u "an/ ,a,u ()n/an 4*,u+) )-iar







+)r*-*- >@? )7a- 5 a!un "an/ ,a,u )a6i



O 3 SSG$$M

P 3

Di) H)6ar II

In


15/36

TD 3 120%0 ++H/

N 3 %:+)ni

P 3 20+)ni

S 3 =:: $

An >@? I- >@?

DVS R92 8+H2O

BP 3 V)i-u,)r BT 3 R! 99 ! 99


A.( 3 P)ria,i- >@? -)an n*r+a,


8!u@?

E- 3 E()+a >@@? 6a(a 6)(i (an

6r)i.ia,

A 3



P* H)+a)+)i M),)na )#8#



H)6ai D)8*+6)naa

Hi6*a,.u+in)+ia

Pani*6)nia -aua

Hi6)r6,)ni+)

1:12201

;

P)raaan !ari9 5



+in//u "an/ ,a,u ()n/an 4*,u+) )-iar






P 3

Di) H)6ar II

In


16/36


+)r*-*- >@? )7a- 5 a!un "an/ ,a,u )a6i



O 3 SSG$$M

TD 3 120%0 ++H/

N 3 %;+)ni

P 3 20+)ni

S 3 =:' $

An >@? I- >@?

DVS R92 8+H2O BP 3 V)i-u,)r BT 3 R! 99 ! 99


A.( 3 P)ria,i- >@? -)an n*r+a,


8!u@?

E- 3 E()+a >@@? 6a(a 6)(i (an

6r)i.ia,A 3



P* H)+a)+)i M),)na )#8#



H)6ai D)8*+6)naa

Hi6*a,.u+in)+ia Pani*6)nia -aua

Hi6)r6,)ni+)

.**,!ari

Ren/ana Pemeri")aan

9 Fi.r*8an

RESUME

16


17/36

S)*ran/ ,a-i9,a-i uia =& a!un +au- ru+a! a-i ()n/an -),u!an

6)ru +)+.)ar "an/ (ia,a+i )7a- 2 +in//u ).),u+ +au- ru+a!

a-i (iraa-an +)+.)ar 6)r,a!an9,a!an i(a- a(a n")ri 6)ru 8),ana

)raa +)n")+6i (an 6)ru )raa 6)nu!# Mua, (an +una! i(a- a(a

na+un ria"a +una! (ara! a(a 2 +in//u "an/ ,a,u ()n/an 4*,u+)

)-iar 500 88# Naaa+ +)


18/36

!)6ai 6,)n*+)/a," (an a8i)# Hai, )n(*-*6i 3 4ari) )*


19/36

TIN%AUAN PUSTAKA

SIROSIS HEPATIS

I. Ana(omi dan &i)iolo,i He+ar

Hai a(a,a! -),)n7ar )r.)ar (a,a+ u.u! .)ra raa9raa )-iar

1#500/r aau 2 .)ra .a(an *ran/ ()aa n*r+a,# L)a-n"a

).a/ian .)ar (i r)/i* !i6*-*n(ria ()-ra )6i/ari-a (an ).a/ian

-)8i, (i !i6*-*n(ria inira# Hai +)+i,i-i (ua ,*.u ua+a "aiu -anan

(an -iri# L*.u -anan (i.a/i +)n7a(i )/+)n an)ri*r (an 6*)ri*r

*,)!


20/36

Hai +)+6un"ai


21/36

8# M)a.*,i+) 6r*)in 3 ()a+inai aa+ a+in* 6)+.)nu-an ur)u+

unu- +)n/),uar-an a+*nia (ari 8airan u.u! 6)+.)nu-an

6r*)in 6,a+a )ra in)r-*n4)ri .)ra/a+ aa+ a+in* (an

in)i )n"aa ,ain (ari aa+ a+in*#

Penim#!nan *i(amin dan mineral

Via+in ,aru9,)+a- > ADEK ? (ii+6an (a,a+ !ai 7u/a 4ia+in B 12

)+.a/a (an .)i (a,a+ .)nu-


22/36

aau (i!a+.a )8ara -i+ia *,)! !ai +),i6ui ir*-in (an )rua+a

)+ua !*r+*n )r*i( )6)ri )r*/)n -*ri*, (an a,(*)r*n#

Ha(i #er4!n,)i )e#a,ai ,!dan, darah dan 4il(ra)i

Hai a(a,a! *r/an 4)n*a "an/ +a+6u .)-)r7a ).a/ai )+6a

6)na+6un/an (ara! "an/ .)r+a-na aa 4*,u+) (ara! .)r,).i!an

(an +a+6u +)n"u6,ai (ara! )-ra (i aa -)-uran/an 4*,u+)

(ara!# Sinu*i( !ai +)ru6a-an ()6* (ara! "an/ +)n/a,ir -)+.a,i

(ari 4)na 8a4a >/a/a, 7anun/ -anan?# -)r7a


23/36

P)n").a. (ari ir*i !)6ai an/a .an"a- na+un +a"*ria

6)n()ria ir*i aa,n"a +)ru6a-an 6)n()ria 6)n"a-i !ai -r*ni "an/

(i).a.-an *,)! 4iru !)6aii aau 6)n()ria )a*!)6aii "an/

.)r-aian ()n/an -).iaaan +inu+ a,-*!*, aau6un *.)ia# B).)ra6a

)i*,*/i ,ain (ari 6)n"a-i !ai -r*ni (ianaran"a a(a,a! in8!i**+iai? 6)n"a-i au*i+un "an/ +)n")ran/ !)6a*i aau

)6i), .i,i)r 6)n"a-i !ai .aaan 6)n"a-i +)a.*,i8 )6)ri i,*n

(i)a) -*n(ii inar8*i(*i? )+)!*r)a) (an !i6)r4ia+in*i A? (an -),ainan 4a-u,ar .ai- "an/

(i(a6a aau6un .aaan# B)r(aar-an !ai, 6)n),iian (i In(*n)ia 4iru

!)6aii B +)ru6a-an 6)n").a. )r)rin/ (ari ir*i !)6ai "aiu

).)ar ;0950 -au (ii-ui *,)! 4iru !)6aii $ ()n/an =09;0

-au )(an/-an 10920 ian"a i(a- (i-)a!ui 6)n").a.n"a (an

)r+au- -),*+6*- 4iru .u-an B (an $# $# S)+)nara iu a,-*!*,

).a/ai 6)n").a. ir*i (i In(*n)ia +un/-in -)8i, )-a,i -*+6)naa? +),i6ui 6)raaan +u(a! ,),a! (an ,)+a ),)ra +a-an

.)r-uran/ 6)raaan 6)ru 6)nu! (an -)+.un/ +ua, )ra .)ra .a(an

+)nurun# K)+u(ian a6a.i,a ir*i u(a! +)n8a6ai in/-a ,an7u >ir*i

()-*+6)naa? /)7a,a9/)7a,a ,).i! +)n*n7*, )6)ri i+.u,n"a -*+6,i-ai-)/a/a,an !ai (an !i6)r)ni 6*ra )6)ri -)r*n*-an ra+.u .a(an

/an//uan i(ur ()+a+ a- .)/iu in//i !in//a 6)n(ara!an a,uran

8)rna aa# Ba!-an /)7a,a ,ain (a6a .)ru6a a(an"a /an//uan

6)+.)-uan (ara! 6)r(ara!an /ui )6ia-i i-)ru air -)n8in/

.)rarna -)8*-),aan )6)ri )! +una! (ara! (a6a i+.u, +),)na

)ra 6)ru.a!an +)na, +),i6ui +u(a! ,u6a u-ar -*n)nrai .in/un/

23


24/36

a/iai a+6ai -*+a# Ria"a -*nu+i a,-*!*, (anaau 6)n"a-i -unin/

7u/a +)ru6a-an


25/36

Pa(a ir*i 6)nin/-aan r)i)ni 4a-u,ar inra !)6ai-

(i).a.-an 7u/a *,)! -)i(a-)i+.an/an anara 4a*-*nri-*r (an

4a*(i,a*r "an/ +)ru6a-an a-i.a (ari -)a(aan ir-u,ai "an/

!i6)r(ina+i- ()n/an 4a*(i,aai ar)ri 6,an-ni- (an ar)ri i)+i-#

Hi6)r)ni 6*ra (ian(ai ()n/an 6)nin/-aan cardiac output (an

6)nurunan r)i)ni 4a-u,ar i)+i-#10

. Pemeri")aan Pen!n5an,

Pa(a 6)+)ri-aan ,a.*ra*riu+ (a6a (i6)ri-a )


26/36

)rua+a 6a(a ir*i ()n/an a8i) (i+ana !a, ini (i-ai-an ()n/an

-)i(a-+a+6uan )--r)i air .).a# S),ain (ari 6)+)ri-aan EVL?#11

26


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I. -ia,no)i)

Pa(a a(iu+ -*+6)nai )+6urna u,i +)n)/a--an (ia/n*i

ir*i !ai# Pa(a 6r*) ,an7uan (ari -*+6)nai )+6urna +un/-in

.ia (i)/a--an (ia/n*i ()n/an .anuan 6)+)ri-aan -,ini "an/

8)r+a ,a.*ra*riu+ .i*-i+ia)r*,*/i (an 6)+)ri-aan 6)nun7an/ ,ain#

Pa(a aa ini 6)n)/a-an (ia/n*i ir*i !ai )r(iri aa 6)+)ri-aan

u.-,ini? ()n/an


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n)ur*ran+i)r 6a,u >"ra+in) *8*6a+in) (an

.)a6!)n",)!an*,a+in)? a+*nia (an /a++a9a+in*.u"ri8

a8i( >GABA?# K),ainan ,a.*ra*ri 6a(a 6ai)n ()n/an

)n) 1 /(L ? "an/ 7u/a +)+i,i-i

-an(un/an -*+6,)+)n "an/ r)n(a! "an/ 6a(a a-!irn"a

+)n").a.-an r)n(a!n"a a-i4ia *6*niai# PBS (i).a.-an

*,)! -ar)na a(an"a ran,*-ai .a-)ri +)n)+.u (in(in/ uu

(an 7u/a *,)! -ar)na 6)n").aran .a-)ri )8ara !)+a*/)n#

Ba-)ri 6)n").a.n"a anara ,ain escherechia coli

streptococcus pneumoniae 6)i) -,).i),,a (an *r/ani+))n)ri- /ra+ n)/ai< ,ainn"a# Dia/n*) SBP .)r(aar-an

6)+)ri-aan 6a(a 8airan ai) (i+ana (i)+u-an ),

6*,i+*r


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-*+6,i-ai a8i)# Sin(r*+ ini (ia-i.a-an *,)! 4a*-*nri-i

(ari ar)ri /in7a, .)ar (an -)8i, )!in//a +)n").a.-an

+)nurunn"a 6)r


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+a-i+a, 1:0+/!ari# Parain)i ai) (i,a-u-an a6a.i,a a8i)

an/a .)ar# Biaan"a 6)n/),uarann"a +)n8a6ai ;9: ,i)r (an

(i,in(un/i ()n/an 6)+.)rian a,.u+in# O.a !)+*ai- .)ru6a

aa+ ran)-a+a (an 6r*6an*,*, unu- +)n/!in(ari )r7a(in"a

6)r(ara!an a,uran 8)rna a-i.a 6)8a!n"a 4ari)# O.a 6),in(un/

+u-*a ,a+.un/ 7u/a (a6a (i.)ri-an a/ar i(a- )r7a(i 6)r(ara!an

a-i.a )r*i /ar*6ai !i6)r)ni 6*ra#1

I;. Pro,no)i)

Pr*/n*i ir*i an/a .)r4ariai (an (i6)n/aru!i *,)! )7u+,a!


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Ria"a a-i -unin/ >@? 12 a!un "an/ ,a,u# Ria"a (ia.)) (an

!i6)r)ni i(a- a(a# Ria"a +inu+ a,-*!*, >9?# Ria"a +)r*-*- >@?

)7a- 5 a!un "an/ ,a,u )a6i .)r!)ni )7a- +au- ru+a! a-i aa +au

(i*6)rai !)rnia = +in//u "an/ ,a,u

Pa(a 6)+)ri-aan @?# P)+)ri-aan anu (i)+u-an

!)+*rr!*i( >@?# Pa(a )-r)+ia 7u/a (i)+u-an a(an"a )()+a 6a(a

-)(ua un/-ai .aa! (an )ri)+a 6a,+ari >@?#

Pa(a -au ini 6a(a 6)+)ri-aan


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B)r(aar-an 6)+)ri-aan USG a.(*+)n 6a(a 6ai)n ini

(i(a6a-an -)an .)ru6a a(an"a 6,)n*+)/a," ()n/an an(a9an(a

6)n"a-i !ai -r*ni "an/ (i)rai a8i) "an/ +)ru6a-an a,a! au

an(a (ari -)/a/a,an


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6)nurunan .)ra .a(an 05 -/!ari an6a )()+a -a-i aau 1-/!ari

()n/an )()+a -a-i# A6a.i,a 6)+.)rian 6ir*n*,a-*n i(a- a()-ua (a6a

(i.)ri-an -*+.inai .)ru6a


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34


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-A&TAR PUSTAKA

1# Nur(7ana! S# Sir*i H)6ai# In3 Su(*"* A S)i"*!a(i B A,4i I

Si+a(i.raa MK S)iai S >)(?# Bu-u A7ar I,+u P)n"a-i Da,a+

5! )(# Ja-ara D)6ar)+)n I,+u P)n"a-i Da,a+ Fa-u,a

K)(*-)ran In(*n)ia# 200 Pa/) ::%9:'=#

2# Lin()! G,)n(a N# Gan//uan !ai -an(un/ )+6)(u (an

6an-r)a# Da,a+ 3 Pri8) S",4ia A# i,*n L*rrain) M# Pa*


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10#R*.)r S# Ra!i+i D*n $# R*8-)"# $*+6,i8ai*n *< $irr!*i# $urr

O6in Gar*)n)r*,# 2012# 2%>=?322=922&

11.Gua(a,u6) Gar8ia9Ta*# Pr)4)ni*n an( Mana/)+)n *

sirosis hepatis .docx

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