ba darina pritonitis tb.doc

7/21/2019 BA Darina Pritonitis TB.doc

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BAB I

LAPORAN KASUS

BAGIAN ILMU PENYAKIT DALAM RS BUDHI ASIH

DESEMBER 2015

Ruang rawat : 609

Tanggal masuk RS : 10 November 2015

1.1 Identitas Pasien

• RM : 01004458

• Nama : Ny !

• "en#s $elam#n : %erem&uan

• 's#a : 46 t(

• )lamat : "l $am&ung &engarengan* "akarta T#mur

• )gama : +slam

• %eker,aan : +bu ruma( tangga

• Status %ern#ka(an : Men#ka(



1 2 A i

(anya makan 13 sen-ok bubur %as#en merasa sesak yang (#lang t#mbul

%as#en &#&#s se-#k#t -an belum /)/ se,ak 1 m#nggu SMRS

R#wayat %enyak#t $eluarga

!alam keluraga &as#en -#-a&atkan r#wayat &enyak#t l#ver 3* gula -ara( 3*

(#&ertens# 3* stroke 3* g#n,al 3* &aru * alerg# 3

R#wayat %engobatan

%as#en t#-ak mem#l#k# r#wayat konsums# obat3obat se.ara rut#n

R#wayat $eb#asaan

Suam# &as#en meroko bungkus &er (ar#* &as#en ser#ng ter&a&ar asa&

rokok %as#en suka mengkonsums# makanan &e-as -an asam* ,arang berola(

raga $onsums# alko(ol 3* narkoba 3

R#wayat 7#ngkungan

% # t# l -# t t - t - - k ( b - t t



1.! Pee"i#saan $isi#

Keadaan U% Ta&a# Sa#it Sedan'( &%)at *+,

Kesada"an ;om&os Ment#s

Tanda -ita

T! : 110<=0 mmg

R : =2 ><men#t

RR : 20 ><men#t

Su(u : =?;

Stat%s Gi/i

// : 42 kg

T/ : 150 .m

/M+ : 186

Stat%s Gene"ais

Ke&aa

Mata Kn%n'tia aneis *+3+,( sklera #kter#k 3<3* sekret 3<3*

&u&#l #sokor <* releks .a(aya langsung -an t#-ak

langsung <

Hid%n' /entuk normal* sekret 3<3* &erna&asan .u&#ng (#-ung 3*

-e # # e t < (# e t # k k <



• /atas &aru 3 (e&ar : +;S @+ gar#s m#-.lav#.ular#s -e>tra*

&eran,akan &a-a 2 ,ar# -# bawa( .ostae gar#s

m#-.lav#.ular#s -e>tra

• /atas &aru 3 ,antung kanan : +;S ++3+;S +@ l#nea &ara

sternal#s -e>tra

• /atas &aru 3 ,antung k#r# : +;S @+ l#nea m#-.lav#.ular#s

s#n#stra• /atas &aru 3 atas ,antung : +;S ++ l#nea &arasternal#s

s#n#stra

)uskultas#

• %aru : Suara na&as ves#kuler 3<3 melema( &a-a

(em#t(oraks kanan* ronk# 3<3* w(eeA#ng 3<3• "antung : S1BS2* #rama regular 80><men#t* murmur 3*

gallo& 3

A4den +ns&eks#

• Pe"%t )e4%n'( sagg#ng o t(e lanks 3

• Carna kul#t sawo matang* t#-ak a-a kemera(an*



bawa(

• T#-ak ter-a&at oe-em &a-a ekstrem#tas atas -an bawa(%al&as#

• )kral teraba (angat

• De-em &a-a ke-ua ekstrem#tas bawa( 3

• Nyer# tekan 3

• ;RT E 2 -et#k

1.8 Pee"i#saan Pen%nan'

Pee"i#saan Hasi Sat%an Niai N"a

HEMATOLOGI

Heat'i R%tin

Le%#sit 19.: "i4%3dL !.: ; 10.9

E"it"sit !.0 %ta3<L 8.= ; 5.>

H 4i > 0 3dL 1! 2 1= !



Nat"i% *Na, 12> 3L 1!5155

Kai% *K, 9.2 3L !.95.5

K"ida *6, >= 3L >:10>

1.5 Ren)ana Dia'nsti#

• RD )b-omen &os#s#

• 'S )b-omen

• ;T S.an )b-omen

• $

• RD T(orak

• !S*• 'reum<;reat#n#n

1.9 Penataa#sanaan

%a-a &as#en #n#* tera&# yang -#ber#kan antara la#n :

• NnMedi#aentsa

3 T#ra( bar#ng



1.: Rin'#asan

%as#en ny! 46 ta(un -atang ke RS /u-(# )s#( se,ak 1 m#nggu SMRS mengalam#

kelu(an nyer# &erut * &erut membesar * mual * munta( 3* nasu makan

menurun * sesak (#lang t#mbul * &as#en &#&#s se-#k#t * belum /)/*

tam&ak Sak#t Se-ang* &u.at * .on,ungt#va anem#s <* b#b#r &u.at* &erut

.embung* b#s#ng usus menurun* .(essboar- &(enomenon * un-ulas# * ;@)

<* nyer# tekan &a-a seluru( reg#o ab-omen * leukos#t 16800* (emoglob#n 9*

ureum 144* kreat#n#n 14*1* kal#um 6*2* album#n *1* 7! 50* )!: &( =48* %D2

11=* ur#nal#s#s: ur#n keru(* album#n * -ara( 2* leukos#t &enu(<7%/* !3-#mer

2*2* 'S ab-omen (#-roneros#s* (#-roureter* -an as.#tes

1.: Masaa

1 %er#ton#t#s T/ --<+leus obstrukt#

2 ).ute on ;$!

)nem#a

4 #&erkalem#a

5 #-roneros#s I #-roureter

6 # lb # #



2. A)%te n 6KD

).ute on ;$! -#tegakkan ber-asarkan &#&#s se-#k#t* ureum 144* kreat#n#n

14*1* album#n ur#

Ren.ana -#agnost#k :

– 'S )b-omen

– %antau balan.e .a#ran

Ren.ana tera&# :

3 )m#noral >2

Ren.ana e-ukas# :

3 /atas# asu&an .a#ran

!. Aneia

)nem#a -#tegakkan ber-asarkan lemas * .on,ungt#va anem#s <* b#b#r

&u.at * b 9


– Mon#tor b 2T7



5. Hid"neC"sis id"%"ete"

#-roneros#s I (#-roureter -#tegakkan ber-asarkan &#&#s se-#k#t* 'S

ab-omen #-roneros#s I (#-roureter


– Ro ab-omen &os#s#

Ren.ana tera&# :

3 nerostom#

Ren.ana e-ukas# :

3 /atas# asu&an .a#ran

9. Hi&a4%ineia

#&oalbum#nem#a -#tegakkan ber-asarkan album#n *1


– ;ek album#n

– SDT<S%T

Ren.ana tera&# :

)lb # 20G 100



113112015

S%4e#tiC O4e#tiC Anaisis Pe"en)anaan

%erut kanan bawa(

sak#t * mual *

nyer# ulu (at# *

belum /)/ 1 m#nggu*

ser#ng sen-awa

Tan-a v#tal : T!: 110<=0mmg N: =2><mnt

S : =º; R: 20><mnt

$e&ala : Kn%n'tia aneis *+3+,* %; 3<3*

sklera #kter#k 3<3

7e(er : %embesaran kelen,ar t#ro#- -an $/ 3

T(oraks : S1 -an S2 reguler* murmur 3* gallo& 3

SN@ <* r(onk# 3<3* w(eeA#ng 3<3

)b-omen : B%n)it( BU *+, ( n7e"i te#an &ada

#%ad"an #anan 4aFa *+,(

diaete" >!(5 )

kstrem#tas : )kral (angat <* oe-em tungka# 33<33

NT keru(

1 +leus obstrukt#

2 ;$!

)nem#a

4 #&erkalem#a


• %asang NT

• $

• RD T(orak

• RD )b-omen &os#s#

• 2T7* !S* 'r<;r*

)!

Ren.ana tera&# :

• +@H! )ser#ng<12 ,am

• ;eo&eraAone 2>1gr

• )l#nam#n H >1

• Tora-os#. 2>1

• Neurob#on 2>1

• Ne>#um 1>1

• !ul.ola> su&&

• )sam olat 1>

• ;a;o >1

• )m#noral >2

• $al#take >1

•%ro&e&sa syr >1

11<1132015

10




KIMIA KLINIK

ANALISIS GAS DARAH

%( =40 =53=45

&6O2 21 H' !585

&O2 108 H' :0100

Bi#a"4nat *H6O!, 1! 3L 212:

Tta 6O2 18 3L 2!2=

Saturas# D2 98 G 953100

Kee4ian 4asa *BE, >.2 E3L 2.52.5

123112015


11



%erut kanan bawa(

sak#t * mual *

nyer# ulu (at# *

belum /)/ 1 m#nggu*

ser#ng sen-awa


S : =º; R: 20><mnt


sklera #kter#k 3<3



SN@ <* r(onk# 3<3* w(eeA#ng 3<3



diaete" >!(5 )


NT .oklat

1 +leus obstrukt#

2 ;$!

)nem#a4 #&erkalem#a


• 'S )b-omen

• %uasa

• 2T7

Ren.ana tera&# :

•+@H! $aNM :)ser#ng 2:1<8 ,am


• )l#nam#n H >1

• Tora-#s#. 2>1

• Neurob#on 2>1

• Ne>#um 1>1

• !ul.ola> su&&

• )sam olat 1>

• ;a;o >1

• )m#noral >2

• $al#take >1

• %ro&e&sa syr >1

• %anso&raAole 2>1

• Ran#t#-#n 2>1

12<1132015

12



1!3112015

13

USG Abdomen

Kesan :

Hidronefrosis et

!dro"reter bi#atera#

as$ites




%erut kanan bawa(

sak#t * mual *

nyer# ulu (at# * /)/

warna agak &ut#(se-#k#t keras

Tan-a v#tal : T!: 90<60<=0mmg N: 108><mnt

S : =º; R: 2><mnt


sklera #kter#k 3<3



SN@ <* r(onk# 3<3* w(eeA#ng 3<3



diaete" >!(5 )


1 NT (#tam

2 'M' 1=00

1 +leus obstrukt#

2 ;$!

)nem#a

4 #&erkalem#a

5 #-roneros#s6 #-roureter


• $onsul urolog#

• S.reen#ng !

•2T7<8 ,am

• b E9 J %R;

Ren.ana tera&# :

• +@H! $aNM :

Ren>am#n 2:1<8 ,am

• %R; 400..


• )l#nam#n H >1

• Tora-#s#. 2>1

• Neurob#on 2>1

• Ne>#um 1>1

• !ul.ola> su&&

• )sam olat 1>

• ;a;o >1

• )m#noral >2

• $al#take >1

• %ro&e&sa syr >1


• Ran#t#-#n 2>1

1<1132015

14



Pee"i#saan Hasi Sat%an Niai N"a Pee"i#saan Hasi Sat%an Niai N"a

HEMATOLOGI

Heat'i R%tin

KIMIA KLINIK

HATI

A4%in !.1 '3dL !.55.2

Le%#sit 11.= "i4%3dL !.: ; 10.9 ANALISIS GAS DARAH

E"it"sit 2.= %ta3<L 8.= ; 5.> %( =41 =53=45

He'4in =.9 '3dL 1!.2 ; 1=.! &6O2 29 H' !585

Heat#"it 2! ? 80 ; 52 &O2 11= H' :0100

Trombos#t 206 r#bu<m.7 150 F 440Bi#a"4nat

*H6O!,1= 3L 212:

M;@ 850 7 80 F 100 Tta 6O2 1: 3L 2!2=

M; 285 %g 26 F 4 Saturas# D2 9= G 953100

M;; 5 g<-7 2 F 6Kee4ian 4asa

*BE, 9.8 E3L 2.52.5

RD 1=.1 ? 18

183112015


15



Mual * nyer# ulu

(at#


S : =º; R: 20><mnt


sklera #kter#k 3<3

7e(er : %embesaran kelen,ar t#ro#- -an $/ 3T(oraks : S1 -an S2 reguler* murmur 3* gallo& 3

SN@ <* r(onk# 3<3* w(eeA#ng 3<3



diaete" >!(5 )


NT ,ern#(

1 +leus obstrukt#

2 ;$!

)nem#a4 #&erkalem#a

5 #-roneros#s

6 #-roureter

= (#&oalbum#n


• %asang !;

• 'M'<(ar#

• Ru,uk nerostom#

Ren.ana tera&# :

•

+@H! $aNM :Ren>am#n 2:1<8 ,am


• )l#nam#n H >1

• Tora-#s#. 2>1

• Neurob#on 2>1

• Ne>#um 1>1

• !ul.ola> su&&

• )sam olat 1>

• ;a;o >1

• )m#noral >2

• $al#take >1

• %ro&e&sa syr >1


• Ran#t#-#n 2>1

• @#t $ >1

• $alne> >1

153112015S%4e#tiC O4e#tiC Anaisis Pe"en)anaan

Mual * nyer# ulu

(at#


S : =º; R: 20><mnt

1 +leus obstrukt#

2 ;$!

)nem#a


• %asang ;!7

16




sklera #kter#k 3<3



SN@ <* r(onk# 3<3* w(eeA#ng 3<3)b-omen : B%n)it( BU *+, ( n7e"i te#an &ada


diaete" >!(5 )


NT ;oklat

'M' 3250

4 #&erkalem#a

5 #-roneros#s

6 #-roureter = #&oalbum#n

• $onsul anestes#

Ren.ana tera&# :

• +@H! $aNM :

Ren>am#n 2:1<8 ,am

•

%R; 00..• ;eo&eraAone 2>1gr

• )l#nam#n H >1

• Tora-#s#. 2>1

• Neurob#on 2>1

• Ne>#um 1>1

• !ul.ola> su&&

• )sam olat 1>

• ;a;o >1

• )m#noral >2

• $al#take >1• %ro&e&sa syr >1


• Ran#t#-#n 2>1

• @#t $ >1

• $alne> >1

15<1132015

Pemeriksaan Hasil Satuan Nilai

NormalHEMATOLOGI

17



Leukosit 12.3 ribu/dL 3. " 1#.$

Eritrosit 3.1 %uta/&L '.( " ).*

Hemo+lobin .* +/dL 13.2 " 1(.3

Hematokrit 2$ , '# " )2

Trombosit 171 rib"%m$& 150 ' 440

M- 84(0 f& 80 ' 100

M-H 28(6 )* 26 ' 34

M-H- 34(1 *%d& 32 ' 36

0 18(8 + ,14

IMNOSEOLOGI

Anti HI

Sreenin+

ra4id test

-on .ea/tif

-on

.ea/tif

HbsA+

5ualitati6

-on .ea/tif -on

.ea/tif

Anti H- -on .ea/tif -on

.ea/tif

LE0 )# mm/%am #73#

ELE5TOLIT

5alsium 8-a9

9(0

m*%d&

8(410(2

Natrium 8Na9 136 mmo#%& 135155

5alium 859 7(6 mmo#%& 3(65(5

5lorida 8-l9 104 mmo#%& 98109

15<1132015


18



a#t% Pe"da"aan 20 Men#t 136

a#t% Pe4e#%an 120 Men#t 5315

P"t"4in Tie *PT,

Knt" 1420 !et#k

Pasien 1=1 !et#k 1231=

Masa T"4&astin *APTT,

Knt" 2 !et#k

Pasien 298 !et#k 20340

P =40 =53=45

&6O2 29 H' !585

&D2 88 mmg 803100

Bi#a"4nat *H6O!, 19 3L 212:

Tta 6O2 1= 3L 2!2=

Sat%"asi O2 96 G 953100

Kee4ian 4asa *BE, =.0 E3L 2.52.5

U"e% 2=9 mg<-l 134

K"eatinin 1669 mg<-l E12

SGOT 10 m'<-l E

SGPT 11 m'<-l E50

A4%in 4 g<-7 5352

193112015


%erut sak#t * Mual

* nyer# ulu (at# *

Tan-a v#tal : T!: 906=0mmg N: =2><mnt 1 +leus obstrukt#

2 ;$!


19



/)/ 2 kal# S : =º; R: 20><mnt


sklera #kter#k 3<3


T(oraks : S1 -an S2 reguler* murmur 3* gallo&3

SN@ <* r(onk# 3<3* w(eeA#ng 3<3



diaete" >!(5 )


• NT ;oklat

• 'M' =00

)nem#a

4 #&erkalem#a


= #&oalbum#n

• ! ;+TD

Ren.ana tera&# :

• +@H! $aNM :

Ren>am#n 2:1<8 ,am

• !obutam#n SM;

*9..<,am b#la (ab#s gant#-o&am#n 8 m#.ro

• )l#nam#n H >1

• Tora-#s#. 2>1

• Neurob#on 2>1

• !ul.ola> su&&

• )sam olat 1>

• ;a;o >1

• )m#noral >2

• $al#take >1

• %ro&e&sa syr >1


• Ran#t#-#n 2>1

• @#t $ >1

• $alne> >1

• 7evolo>a.#n

1>=50<2(ar#

• %elast#n 2>1gr

Pemeriksaan Hasil Satuan Nilai Normal

Leukosit 28(5 rib"%d& 3(8 ' 10(6

20



Eritrosit 3(6 "ta%& 4(7 ' 5(9

Hemo+lobin 10(4 *%d& 13(2 ' 17(3

Hematokrit 31 + 40 ' 52


M- 84(5 f& 80 ' 100

M-H 28(7 )* 26 ' 34

M-H- 34(0 *%d& 32 ' 36

0 15(2 + ,14

Leukosit 60(8 rib"%d& 3(8 ' 10(6

Eritrosit 2(9 "ta%& 4(7 ' 5(9

Hemo+lobin 8(2 *%d& 13(2 ' 17(3

Hematokrit 25 + 40 ' 52


M- 86(6 f& 80 ' 100

M-H 27(8 )* 26 ' 34

M-H- 32(1 *%d& 32 ' 36

0 15(1 + ,14

1=3112015

21




/)/ (#tam 1 kal#*

batuk * -a(ak

warna kun#ng* lemas

* Mual * nyer#ulu (at#

Tan-a v#tal : T!: 80<60<=0mmg N: =2><mnt

S : =º; R: 20><mnt


sklera #kter#k 3<3



SN@ <* r(onk# 3<3* w(eeA#ng 3<3



diaete" >!(5 )


• !#lakukan !

• 'M' 3200

1 +leus obstrukt#

2 ;$!

)nem#a

4 #&erkalem#a


= #&oalbum#n


• )!* N)$*2T7

• !S<,am selama 6 ,am

Ren.ana tera&# :• +@H! $aNM :

Ren>am#n 2:1<8 ,am

• +@H! Ren>am#n

lasal<12 ,am

• Tera&# la#n lan,ut

1=<1132015


22



HEMATOLOGI

Heat'i R%tin

KIMIA KLINIK

ANALISIS GAS DARAH

Le%#sit 2:.2 "i4%3dL !.: ; 10.9 %( =41 =53=45

E"it"sit 2.: %ta3<L 8.= ; 5.> &6O2 25 H' !585

He'4in :.8 '3dL 1!.2 ; 1=.! &D2 91 mmg 803100

Heat#"it 2! ? 80 ; 52Bi#a"4nat

*H6O!,19 3L 212:

T"4sit 5: "i4%3)L 150 ; 880 Tta 6O2 1= 3L 2!2=

M;@ 80 7 80 F 100 Saturas# D2 96 G 953100

M; 299 %g 26 F 4Kee4ian 4asa

*BE,9.> E3L 2.52.5

M6H6 !9.1 '3dL !2 ; !9

ELEKTROLIT

ELEKTROLIT SERUM

RD 15.> ? 18 Nat"i% *Na, 1!1 3L 1!5155

Kai% *K, =.2 3L !.95.5

$lor#-a ;l 10 mmol<7 983109

1:3112015


/)/ (#tam 1 kal#*

batuk * -a(ak

warna kun#ng* lemas


S : =º; R: 20><mnt

1 +leus obstrukt#

2 ;$! on !

)nem#a


• ! ;+TD

23



* Mual * nyer#

ulu (at#


sklera #kter#k 3<3



SN@ <* r(onk# 3<3* w(eeA#ng 3<3)b-omen : B%n)it( BU *+, ( n7e"i te#an &ada


diaete" >!(5 )


• 'M' 1200

• NT (#tam -ara(

4 #&erkalem#a

5 #-roneros#s


• 'M'<(ar#

• N)$* ur<.r* )!* 2T7

• Ru,uk &ersa(abatan .rE5

Ren.ana tera&# :

• +@H! $aNM :

Ren>am#n 2:1<8 ,am• Tera&# la#n lan,ut

18<1132015


ELEKTROLIT

Kasi% *6a, 9.8 '3dL :.810.2

HEMATOLOGI

Heat'i R%tin

24



ELEKTROLIT SERUM Le%#sit 2:.8 "i4%3dL !.: ; 10.9

Nat"i% *Na, 12= 3L 1!5155 E"it"sit !.8 %ta3<L 8.= ; 5.>

Kai% *K, :.0 3L !.95.5 He'4in >.9 '3dL 1!.2 ; 1=.!

$lor#-a ;l 98 mmol<7 983109 Heat#"it 2: ? 80 ; 52

METABOLISME KARBOHIDRAT T"4sit 95 "i4%3)L 150 ; 880

G%#sa Da"a @a 1:.00 280 '3d 110 M6- :!.! CL :0 ; 100

G%#sa Da"a @a 1>.00 19> '3d 110 M6H 2:.! P' 29 ; !8

G%#sa Da"a @a 20.00 212 '3d 110 M6H6 !8.0 '3dL !2 ; !9

G%#sa Da"a @a 21.00 1!8 '3d 110 RD 15.5 ? 18

Pee"i#saan Hasi Sat%anNiai

N"a

KIMIA KLINIK

ANALISIS GAS DARAH

P =.8: =.!5=.85

25



&6O2 29 H' !585

&O2 =2 H' :0100

Bi#a"4nat *H6O!, 20 3L 212:

Tta 6O2 21 3L 2!2=

Saturas# D2 95 G 953100

Kee4ian 4asa *BE, 2.1 E3L 2.52.5

Nat"i% *Na, 1!1 3L 1!5155

Kai% *K, =.2 3L !.95.5

$lor#-a ;l 10 mmol<7 983109

METABOLISME KARBOHIDRAT

GDS >8 '3d 110

GIN@AL

U"e% 2=5 '3d 1!8!

K"eatinin 18.=5 '3d 1.2

1>3112015


/)/ (#tam 2 kal# Tan-a v#tal : T!: 110<80mmg N: =2><mnt

S : =º; R: 20><mnt


1 +leus

obstrukt#

2 ;$! on !

)nem#a


• ;ek ur#n lengka&

• 7!* %T )%TT* !3-#mer

• $onsul &aru

26



sklera #kter#k 3<3



SN@ <* r(onk# 3<3* w(eeA#ng 3<3

)b-omen : B%n)it( BU *+, ( n7e"i te#an &ada#%ad"an #anan 4aFa *+,(

diaete" >!(5 )


4 #&erkalem#a

5 #-roneros#s


Ren.ana tera&# :

• +@H! $aNM :

Ren>am#n 2:1<8 ,am

• HH% 400..


19<1132015


ELEKTROLIT

ELEKTROLIT SERUM

KIMIA KLINIK

GIN@AL

Nat"i% *Na, 1!1 3L 1!5155 U"e% 2:= '3d 1!8!

27



Kai% *K, =.8 3L !.95.5 K"eatinin 15.58 '3d 1.2

$lor#-a ;l 102 mmol<7 983109 ELEKTROLIT SERUM

METABOLISME KARBOHIDRAT Nat"i% *Na, 1!0 3L 1!5155

G%#sa Da"a @a 01.00 121 '3d 110 Kai% *K, =.2 3L !.95.5

G%#sa Da"a @a 02.00 1!9 '3d 110 $lor#-a ;l 102 mmol<7 983109

G%#sa Da"a @a 0!.00 5:> '3d 110HEMATOLOGI

7! 5 mm<,am 030

G%#sa Da"a @a 08.00 !!5 '3d 110

G%#sa Da"a @a 05.00 120 '3d 110

G%#sa Da"a @a 09.00 128 '3d 110

G%#sa Da"a @a 0=.00 12= '3d 110

G%#sa Da"a @a 22.00 !00 '3d 110

G%#sa Da"a @a 2!.00 1!0 '3d 110

G%#sa Da"a @a 00.00 121 '3d 110

203112015


ke,ang K20 -et#k

seluru( ba-an* akral-#ng#n* mulut berbusa*

munta( 5 kal# setela(

m#num obat .a#r *

Tan-a v#tal : T!: 120<80mmg N: =2><mnt

S : =º; R: 20><mnt


sklera #kter#k 3<3

8 %er#ton#t#s

T/9 +leus

obstrukt#

10 ;$! on !


• ;T S.an• ! sebelumnya &asang

;!7

• Nerostom#

28



&ut#( * am&as 3*

/)/ (#,au* b#ru3b#ru -#

&erut



SN@ <* r(onk# 3<3* w(eeA#ng 3<3


#%ad"an #anan 4aFa *+,(diaete" >> )

)ess4a"d &enenn *+,


• NT ,ern#(

11 )nem#a

12 #&erkalem#a


15 #&oalbum#n

16 !+;

• Mantou> test

• $onsul neurolog#

Ren.ana tera&# :

• +@H! $aNM :

Ren>am#n 2:1<8 ,am

•

D2 2l#ter<men#t• !#aAe&am 2*5.. bolus

• su.t#on

• Hen#to#n am&<24 ,am

-alam na.l 0*9G 50..

s(yr#nge &um&

• %R; 00..


20<1132015


ELEKTROLIT SERUM URIN LENGKAP

Nat"i% *Na, 1!0 3L 1!5155 Carna $un#ng $un#ng

Kai% *K, =.! 3L !.95.5 Kee"nian A'a# #e"% @e"ni

29



$lor#-a ;l 104 mmol<7 983109 lukosa Negat# Negat#

$AAL HEMOSTASIS /#l#rub#n Negat# Negat#

%rotromb#n T#me %T $eton Negat# Negat#

$ontrol 140 !et#k %( 60 4638

%as#en 168 !et#k 1231= /erat ,en#s 1025 10053100

Masa Trombo&last#n )%TT A4%in %"in !+ Ne'atiC

$ontrol 5 !et#k 'rob#l#nogen 02 '<-l 0131

%as#en 21 !et#k 20340 N#tr#t Negat# Negat#

Ddie" 5.2 '3L 0.! Da"a 2+ Ne'atiC

ELEKTROLIT SERUM Este"ase e%#sit !+ Ne'atiC

Nat"i% *Na, 12> 3L 1!5155 S!+MN 'R+N

Kai% *K, =.= 3L !.95.5 Le%#sit Pen% 3LPB 5

K"ida *6, 102 3L >:10> E"it"sit Ban7a# 3LPB 2

ELEKTROLIT SERUM &#tel %os#t# <7%/ %os#t#

Nat"i% *Na, 1!! 3L 1!5155 S#l#n-er Negat# <7%$ Negat#

Kai% *K, =.2 3L !.95.5 $r#stal Negat# Negat#

$lor#-a ;l 101 mmol<7 983109 /akter# Negat# Negat#

"amur Negat# <7%/ Negat#

30



ELEKTROLIT SERUM

Nat"i% *Na, 1!! 3L 1!5155

Kai% *K, =.2 3L !.95.5

K"ida *6, 101 3L >:10>


METABOLISME KARBOHIDRAT

G%#sa Da"a @a 01.00 22! '3d 110

G%#sa Da"a @a 02.00 1=: '3d 110

G%#sa Da"a @a 0!.00 1=8 '3d 110

31



G%#sa Da"a @a 08.00 121 '3d 110

G%#sa Da"a @a 05.00 11! '3d 110

G%#sa Da"a @a 09.00 :> '3d 110

G%#sa Da"a @a 0=.00 !!9 '3d 110

G%#sa Da"a @a 0:.00 155 '3d 110

G%#sa Da"a @a 0>.00 1!: '3d 110

G%#sa Da"a @a 10.00 11: '3d 110

G%#sa Da"a @a 1:.00 122 '3d 110

G%#sa Da"a @a 1>.00 1!0 '3d 110

G%#sa Da"a @a 20.00 10= '3d 110

G%#sa Da"a @a 22.00 19! '3d 110

G%#sa Da"a @a 2!.00 9! '3d 110

G%#sa Da"a @a 00.00 =5 '3d 110

20<1132015


HEMATOLOGI

Heat'i R%tin

Le%#sit 15.! "i4%3dL !.: ; 10.9

E"it"sit 2.! %ta3)L 8.= ; 5.>

32



He'4in 9.: '3dL 1!.2 ; 1=.!

Heat#"it 1> ? 80 ; 52

T"4sit 98 "i4%3)L 150 ; 880

7! 2 mm<"am 030

M;@ 88 7 80 F 100

M; 294 %g 26 F 4

M;; 50 g<-7 2 F 6

RD 15.5 ? 18

Hit%n' @enis

• /aso#l

• EsinCi

• Net"Ci 4atan'

• Net"Ci se'en

• LiCsit

• Monos#t

0

0

0

::

5

=

G

?

?

?

?

G

031

28

!5

50=0

2580

238

20<1132015


ELEKTROLIT SERUM

Nat"i% *Na, 1!2 3L 1!5155

Kai% *K, 9.= 3L !.95.5

$lor#-a ;l 101 mmol<7 983109

33



Caktu %er-ara(an 200 Men#t 136

Caktu %embekuan 1200 Men#t 5315

%rotromb#n T#me %T

$ontrol 1420 !et#k

%as#en 155 !et#k 1231=

Masa Trombo&last#n )%TT

$ontrol 5 !et#k

%as#en 290 !et#k 20340

Nat"i% *Na, 1!! 3L 1!5155

Kai% *K, 9.: 3L !.95.5

$lor#-a ;l 104 mmol<7 983109

%ro.als#ton#n /a(an belum

213112015


ke,ang seluru( ba-an*

mulut berbusa* munta(

10 kal# setela( m#num

obat* .a#r * &ut#(* am&as 3* /)/

(#,au* b#ru3b#ru -#

&erut* lengan kanan

Tan-a v#tal : T!: 140<80mmg N: =2><mnt

S : =º; R: 20><mnt

$e&ala : Kn%n'tia aneis *+3+,* %; 3<3* sklera #kter#k 3<3


1 %er#ton#t#s T/2 +leus obstrukt#

;$! on !

4 )nem#a5 #&erkalem#a

6 #-roneros#s

= #-roureter

8 #&oalbum#n


• Dbservas# ke,ang

Ren.ana tera&# :

• +@H! $aNM :

Ren>am#n 2:1<8 ,am

• D2 2l#ter<men#t


34



-an k#r# T(oraks : S1 -an S2 reguler* murmur 3* gallo& 3

SN@ <* r(onk# 3<3* w(eeA#ng 3<3



diaete" >> )


'M' 100

NT (#tam -ara(

9 !+; -alam na.l 0*9G 50..

s(yr#nge &um&


223112015


$e,ang 2 kal#* mata

men-el#k * tangan

k#r# bergerak3gerak*

keluar a#r l#ur*t#-aksa-ar saat ke,ang*

setela( ke,ang &us#ng

ber&utar lalu tert#-ur


S : =º; R: 20><mnt


sklera #kter#k 3<3



1 %er#ton#t#s T/

2 +leus obstrukt#

;$! on !

4 )nem#a

5 #&erkalem#a6 #-roneros#s

= #-roureter

8 #&oalbum#n


• 2T7 &ost %R;

Ren.ana tera&# :

• +@H! $aNM :Ren>am#n 2:1<8 ,am

• D2 2l#ter<men#t


35



SN@ <* r(onk# 3<3* w(eeA#ng 3<3



diaete" >!(5 )


NT (#tam 250..

'M' 500

9 !+; -alam na.l 0*9G 50..

s(yr#nge &um&


2!3112015


$e,ang 0 -et#k*

&enurunan kesa-aran


S : =º; R: 20><mnt


sklera #kter#k 3<3



SN@ <* r(onk# 3<3* w(eeA#ng 3<3


5 +leus obstrukt#

6 ;$!

= )nem#a8 )s#-os#s

9 #&erkalem#a

10 #&okalsem#a


•

Ren.ana tera&# :

• +@H! $aNM :

Ren>am#n 2:1<8 ,am

• D2 2l#ter<men#t

•Hen#to#n am&<24 ,am-alam na.l 0*9G 50..

s(yr#nge &um&


36




diaete" >!(5 )


Mantou> test negat#

2<1132015

0>.00 IB 10.00 IB 10.!0 IB 10.85 IB 10.50 IB

TD 90<60 mmg 80<60 mmg 60 &al&as# T#-ak -a&at -#ukur T#-ak -a&at -#ukur

Nadi 116 ><men#t 68 ><men#t T#-ak teraba T#-ak teraba T#-ak teraba

S%% 66º; 6º; 6º; 5º; 5*º;

RR 16 ><men#t 10><men#t )&neu )&neu )&neu

Lainain )kral -#ng#n %u&#l m#-r#as#s $ )s#stole

Tinda#an • ue-el • ue-el • /agg#ng 10

7<men#t

• /agg#ng 10

7<men#t

%as#en -#nyatakan

men#nggal -un#a

37



• !;

• NT (#tam

• D2 nasal

l#ter<men#t

• !;

• NT (#tam

• D2 nasal

l#ter<men#t

• R"%

• 7oa-#ng Na;l 1

kol

•

!NR

• R"%

38

ba darina pritonitis tb.doc

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