221524892 preskas-ureterolithiasis
TRANSCRIPT
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Presentasi KasusURETEROLITHIASISNatasha Setyasty Primaditta, dr.
Pembimbing: Sylviasari Risgiantini, dr.
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IDENTITAS PASIEN•No. Medrek : 526439•Nama : Ny. JS•Umur : 57 tahun 6 bulan•Jenis Kelamin : Wanita•Alamat : Kp. Muara
RT014/005 Muarabakti, Babelan•Agama : Islam•Tanggal MRS : 26 Juli 2013•Tanggal pemeriksaan: 26 Juli 2013
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ANAMNESIS• Keluhan Utama : Nyeri perut kiri bawah• Pasien sejak 3 hari SMRS mengeluhkan nyeri
perut kiri bawah. Keluhan terjadi secara mendadak, seperti ditusuk-tusuk, dirasakan terus menerus, dan semakin berat. Nyeri dirasakan menjalar ke arah lubang kencing. Keluhan tidak membaik dengan mengubah posisi.
• Keluhan dirasakan sejak 2 bulan SMRS dan pada awalnya dirasakan hilang timbul tidak menentu.
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ANAMNESIS•Keluhan disertai mual, nyeri kepala, nyeri
pinggang. •Pasien sudah tidak mengalami haid sejak 2
tahun yang lalu. •Riwayat keluarga dengan keluhan yang
sama tidak ditemukan. •Tidak ditemukan riwayat alergi, darah
tinggi, dan kencing manis. •Tidak ditemukan riwayat operasi
sebelumnya.
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PEMERIKSAAN FISIK• KU : tampak
sakit ringan• Kesadaran : compos
mentis, gelisah• Tanda vital :
▫ TD : 160/100 mmHg▫ Nadi : 100x/menit▫ RR : 24x/menit▫ Suhu : 36,8O C
• KEPALA▫ Mata konj. anemis -
sklera ikterik -• LEHER
▫ KGB tidak teraba membesar
• THORAKS▫ Pulmo
bentuk dan gerak simetris vbs kiri = kanan; rh (-/-) ;
wh (-/-) ▫ Cor
bunyi jantung murni reguler; murmur (-/-)
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PEMERIKSAAN FISIK• ABDOMEN
▫ tegang▫ BU (+) normal▫ nyeri tekan (+) ar/
hipokondriak kiri ▫ hepar & lien tidak teraba
membesar
• PUNGGUNG▫ ketok cva +/-
• EKSTREMITAS▫ akral hangat; capillary
refill time < 2”
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DIAGNOSIS BANDING•Kolik Abdomen ec. Urolithiasis•Kolik Abdomen ec. Infeksi Saluran Kemih
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LABORATORIUMDARAH URINE LENGKAP• Hemoglobin : 13,8 g/dl• Leukosit :
14.200/mm3
• LED : 5• Eritrosit : 5,9 jt/mm3
• Hematokrit : 47,8• Trombosit :
283.000/mm3
• GDS : 92 mg/dl
• Warna : kuning• Kejernihan : jernih• Berat jenis : 1,025• pH : 6,0• Eritrosit : (-)• Keton : (-)• Bilirubin : (-)• Sedimen : (-)• Leukosit : 1-2• Kristal : (+)
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DIAGNOSIS KERJA•Ureterolithiasis
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PENATALAKSANAAN•Umum
▫Pro rujuk fasilitas dengan Spesialis Bedah Urologi
•Medikamentosa▫IVFD RingAs 20gtt/menit▫Ranitidine 1 amp▫Ondansentron 1 amp▫Ketorolac 1 amp ▫Ciprofloxacin 2x500 mg▫As. Mefenamat 3x500 mg
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PROGNOSIS•Quo ad vitam : ad bonam •Quo ad functionam : dubia ad malam
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ANATOMI & FISIOLOGITRAKTUS URINARIUS
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ANATOMI
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FISIOLOGI
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UROLITHIASISBATU SALURAN KEMIH
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DEFINISI• Urolithiasis adalah suatu keadaan terjadinya
penumpukan oksalat, kalkuli (batu ginjal) pada ureter atau pada daerah ginjal.
• Kalkuli di dalam traktus urinarius dapat menyebabkan nyeri, perdarahan, penyumbatan aliran kemih atau infeksi.
• Kalkuli dapat terbentuk pada :▫Ginjal (Nefrolithiasis)▫Ureter (Ureterolithiasis)▫Vesica urinaria (Vesicolithiasis)▫Uretra (Urethrolithiasis)
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ETIOLOGI
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FAKTOR RISIKO
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PATOGENESIS
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KOMPOSISI BATU
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JENIS-JENIS BATU
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URETEROLITHIASISPEMBAHASAN
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BATU URETER (URETEROLITHIASIS)
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MANIFESTASI KLINIS
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DIAGNOSIS
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DIAGNOSIS
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Diagnosa Banding
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Tatalaksana
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ILUSTRASIESWL URETEROSCOPY
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PEMILIHAN TERAPI
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KOMPLIKASI
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Terimakasih