case evelyn - dr. idil

7/25/2019 Case Evelyn - Dr. Idil

1/41

LAPORAN KASUS EVELYN (406148144)

DAFTAR MASALAH

N

o

Aktif Tanggal Pasif Tanggal

1 Ikterik 23 11

2015

Spe!"#e$%i 24 & 11

20152 'ep%titi 23 11

20153 'ip"%*+#i!

Sek+!,er pr"*e# 4

23 11

20154 Sir"i -ep%r

Sek+!,er pr"*e# 1

24 11

20155 K"eiti%i 24 11

20156 K"et%i

Sek+!,er pr"*e# 5

24 11

2015

RSU. KU.US 2015 P%$e 1


2/41


IDENTITAS PASIEN

N%#% / ! S

U#+r / 4 t%-+!

e!i ke%#i! / L%ki & %ki

A$%#% / I%#

Peker%%! / Pet%!i

A%#%t / S%ri 52 7%%- & .e#%k

%+k R+#%- %kit / 23 N"9e#*er 2015

%!$$% ,ik%+k%! / 25 N"9e#*er 2015

%!$$% ke+%r / 4 .ee#*er 2015

R+%!$ / e%ti 2 .

Pe#*%:%r%! / PS

DATA DASAR

A Anamnesis :A+t"%!%#!ei ,e!$%! pe!,erit% ,%! %"%!%#!ei ,e!$%! itri

pe!,erit% t%!$$% 25 N"9e#*er 2015

Keluhan Utama :N:eri ++ -%tiRia!at Pen!akit Seka"ang :P%ie! ,%t%!$ ,e!$%! ke+-%! !:eri ++ -%ti e%k 6 -%ri SRS N:eri :%!$

,ir%%k%! -i%!$ ti#*+ ,%! #e!%%r %#p%i ke p+!$$+!$ ter+t%#% *i%

#e!$k"!+#i #%k%!%! pe,% ,%! %%# N:eri ti,%k *erk+r%!$ ,e!$%!

k"!+#i "*%t ;%r+!$ N:eri ++ -%ti ,iert%i ,e!$%! ;%r!% k+it ,%! #%t%

#e!%,i k+!i!$ 2 -%ri SRS e#% #+% ke#*+!$ ti,%k #+!t%- ti,%k %,%,e#%# AK %!


3/41


4/41


%t% Mata Kanan / pe!$i-%t%! *%ik k"!+!$ti9%

%!e#i (&) skle"a ikte"ik /10 p+pi i"k"r

,i%#eter 2 ## ree>


5/41


Ektre#it% S+peri"r I!=eri"rPe#*e%r%! ke Li#=e %>i% && &&Pe#*e%r%! ke Li#=e i!$+i!% && &&E,e#% && &&Si%!"i && &&

Pete


6/41



'ep%r Uk+r%! #e!$e


7/41


Ro Tho"a< .8 $ (( $ .9(*

PR6&LEM AKTIF1 Ikterik2 'ep%titi 3 'ip"%*+#i!4 Sir"i -ep%r5 K"eiti%i6 K"et%i i!tr%-ep%tik

REN3ANA PEME3AHAN MASALAHPr"*e# 1 /Ikterik

A / e! / Pe#erik%%! %*"r%t"ri+# e!Ci# tr%!%#i!%e (S7O S7P)

'*A$ *iir+*i! US7 %*,"#e!> / U.?A 3 > 1 A#i!"=+ 1> / Pe#erik%%! e!Ci# tr%!%#i!%e (S7O S7P) *iir+*i!E> / e!e%k%! te!t%!$ pe#erik%%! :%!$ %k%! ,i%k+k%!

Pr"*e# 2 / 'ep%titi

RSU. KU.US 2015 P%$e

Ke%! & ?-"eit-i%i #+tipe& ?irr-"i -ep%r ,e!$%! pe!"#e$%i

& ?-"et%i i!tr%-ep%t% t%k t%#p%k


8/41


A / e! / US7 %*,"#e! 'it+!$ AP > / E!te / &E> / e!e%k%! te!t%!$ pe#erik%%! :%!$ %k%! ,i%k+k%!

Pr"*e# 3 / 'ip"%*+#i!A / e! / &

> / Ke+-%! +*ekti= pe#erik%%! %*"r%t"ri+# k%,%r %*+#i!E> / e!e%k%! kep%,% p%ie! te!t%!$ pe#erik%%! :%!$ %k%!

,i%k+k%!

Pr"*e# 4 / Sir"i -ep%r

A / e! / Pe#erik%%! AP US7 %*,"#e! *i"pi -%ti> / E!te / &E> / e!e%k%! te!t%!$ pe#erik%%! :%!$ %k%! ,i%k+k%!

Pr"*e# 5 / K"eiti%iA / e! / US7 %*,"#e! k"eit"$r%G ,e!$%! k"!tr% ER?P

> / K"!+ ke ,"kter *e,%-

> / &E> / e!e%k%! te!t%!$ pe#erik%%! :%!$ %k%! ,i%k+k%!

Pr"*e# 6 /K"et%i i!tr%-ep%tikA / e!


9/41


RIN5KASANSe"r%!$ %ki %ki +#+r 4 t%-+! ,%t%!$ ,e!$%! ke+-%! !:eri ++ -%ti e%k

6 -%ri SRS N:eri ++ -%ti ,iert%i ,e!$%! ;%r!% k+it ,%! #%t% #e!%,i k+!i!$

2 -%ri SRS AK *er;%r!% eperti te- ,%! ker+- ,%! =ee *er;%r!% k+!i!$

p+ti- 10 -%ri SRS ,%! pe!+r+!%! *er%t *%,%! e*%!:%k 2k$ ,%%# %t+ *+%!

P%,% pe#erik%%! Gik ,%! %*"r%t"ri+# ,i,%p%tk%! -%i e*%$%i *erik+t /Sker% ikterik (BB)J ektre#it% ikterikJ !:eri tek%! epi$%tri+# (B)7%!$$+%! =+!$i -ep%r S7O / 11 S7P / 13 J 'iper*iir+*i!e#i%

(iir+*i! t"t% / 2481 iir+*i! ,irek / 218 iir+*i! i!,irek / 303) J

'ip"%*+#i!e#i% A*+#i! / 32 J 'ep%titi '*A$ (B)

3ATATAN KEMA4UAN%!$$% 30 11 2015Pr"*e# 1 / IkterikS / ;%r!% k+it ,%! #%t% k+!i!$ *erk+r%!$ AK *er;%r!% k+!i!$ =ee

*er;%r!%


10/41


P%ie! ,ip+%!$k%! ,e!$%! "*%t p+%!$ / R%!iti,i!e 2 > 1 t%* ?eG>i#e 2 >

100#$ A#i!"=+i! -ep%r 1 > 1 U.?A 3 > 1

ALUR PIKIR

RSU. KU.US 2015 P%$e 10

N:eri ++ -%ti

e%k 6 -%ri SRSIkterik AK

*er;%r!%

Pe#erik%%!

%* / S7O M

S7P M

iir+*i! t"t% M

iir+*i! ,irek

A*+#i! '*A$US7

%*,"#e!

Sir"i -ep%r?-"et%i?-"eit-i%i 'ep%titi


11/41


ALUR KETERKAITAN MASALAH

RSU. KU.US 2015 P%$e 11

?-"et%i

'iper*iir+*i!e#i Ikterik

?-"eit-i%i

'*A$ (B)

'ep%titi

Sir"i -ep%r'ip"%*+#i!e#i%


12/41


IKTERUS

De>nisi

K%t% jaundice *er%% ,%ri *%-%% Per%!


13/41


pe#*e!t+k%! *iir+*i! tr%!p"r p%#%, liver uptake k"!+$%i ,%! ekkrei *iier

Jaundice ,ie*%*k%! "e- $%!$$+%! p%,% %%- %t+ ,%ri 5 =%e #et%*"i#e

*iir+*i! tere*+t

(' Fase P"ahe2atik

Pre-ep%tik %t%+ -e#"itik :%it+ #e!:%!$k+tjaundice:%!$ ,ie*%*k%! "e- -%&

-% :%!$ ,%p%t #e!i!$k%tk%! -e#"ii (r+%k!:% e ,%r%- #er%-)

% Pe#*e!t+k%! iir+*i! Sekit%r 250 %#p%i 350 #$ *iir+*i! %t%+ ekit%r 4

#$ per k$ *er%t *%,%! ter*e!t+k eti%p -%ri!:%J 0&80F *er%% ,%ri

pe#e


14/41


,%%# retik++# e!,"p%#ik -ep%t"it ,%! ,ik%t%ii "e- e!Ci# *iir+*i!

$+k+r"!"i tr%!=er%e ,%%# re%ki ,+%&t%-%p

+' Fase Pas-ahe2atik

P%


15/41


1 'ep%titi *i% #e!:e*%*k%! -i%!$!:% !%=+ #%k%! mual muntah ,%!

demam

2 Pe!:+#*%t%! e#pe,+ *i% #e!:e*%*k%! $e%% k"et%i

Pengo#atan

Pe!$"*%t%! jaundice %!$%t ter$%!t+!$ pe!:%kit ,%%r pe!:e*%*!:% ik%

pe!:e*%*!:% %,%%- pe!:%kit -%ti (#i%!:% hepatitis virus) *i%%!:% jaundice

%k%! #e!$-i%!$ e%%! ,e!$%! per*%ik%! pe!:%kit!:% e*er%p% $e%% :%!$


16/41


HEPATITIS &

De>nisi %an E2i%emiologi'ep%titi %,%%- pe!:%kit i!=eki 9ir+ -ep%titi (V') p%,% -%ti :%!$ ,%p%t

*eri=%t %k+t %t%+ kr"!i e!+r+t ,%t% H'O 2014 e*i- ,%ri 240 +t% pe!,+,+k ,i

,+!i% #e!$%%#i i!=eki V' kr"!i ,%! e*i- ,%ri 80000 "r%!$ per t%-+!

#e!i!$$% %ki*%t k"#pik%i i!=eki V' %k+t #%+p+! kr"!i Pre9%e!i :%!$ e*i-

ti!$$i ,i,%p%tk%! p%,% !e$%r% *erke#*%!$ ter#%+k I!,"!ei% .i I!,"!ei%

e!,iri ,iperkir%k%! #e!


17/41


,%! tipe A (08F)

er,%%rk%! %!%ii $e!"#i< V' te%- ,iket%-+i *er*%$%i pr",+k pr"tei! ,%ri

V' :%!$ ter,iri %t% e+*+!$ ('A$) pr"tei! !+ke"k%pi, ('


18/41


7%#*%r 1 Per%%!%! pe!:%kit ,%! Pr"G Ser""$i 'ep%titi Ak+t

P%,% k%+ i!=eki V' kr"!i 'A$ ,ite#+k%! tet%p #i!i#% e%#% 6 *+%!

'i!$$% %%t i!ii!=eki V' kr"!i ti,%k ,%p%t ,ier%,ik%i epe!+-!:% k%re!% %,%!:%

#"ek+ covalently closed cicular DNA (


19/41


7%#*%r 2 Per%%!%! pe!:%kit ,%! Pr"G Ser""$i 'ep%titi Kr"!i

%*e 1 Per%%!%! A%#i 'ep%titi Kr"!i

H&eA

g

ALT DNA ?H& Histologi

Hati

Inisias

i

Te"a2i

Imunotole"a

nsi

B N"r#% 20000

IU#L

N"r#% i,%k

Imunoaktif B& e!i!$k%

t

2000

IU#L

I!%#%i

%t%+ G*r"i

,er%%t

ri!$%!&

e,%!$

Y%

Pengi%a2

Inaktif

& N"r#% Q2000

IU#L

Per*%ik%! i,%k

Reakti@asi

/.9=+9 %a"i

2engi%a2

inaktif0

B& e!i!$k%

t

2000

IU#L

I!%#%i

ter%,i

ke#*%i

Y%

Tan%a %an 5eBala

(' 'ep%titi Ak+t



20/41


a' %e pre&ikterik

Ke%,%%! ,i#%!% #+%i #+


21/41


He2atitis

K"onis

H&eAg /=0

B & I$7 & B B&

2 i"ki#i% -%ti

P%,% pe#erik%%! i!i :%!$ ,i*+t-k%! i%%- ASAL (S7OS7P) 77 ALP*iir+*i! %*+#i! $"*+i! ert% pe#erik%%! ,%r%- peri=er e!$k%p ,%! P

U#+#!:% %k%! ,ite#+k%! AL :%!$ e*i- ti!$$i ,i*%!,i!$k%! AS tet%pi

eiri!$ *erke#*%!$!:% pe!:%kit #e!++ ir"i r%i" tere*+t %k%! *er*%ik

i% ir"i te%- ter*e!t+k %k%! t%#p%k pe!+r+!%! pr"$rei= %*+#i!

pe!i!$k%t%! $"*+i! ,%! pe#%!%!$%! ;%kt+ pr"tr"#*i! :%!$ ,iert%i

pe!+r+!%! +#%- tr"#*"it P%,% p%ie! -ep%titi kr"!i per+ ,i%k+k%!

pe#erik%%! &=et"pr"tei! +!t+k #e!,eteki k%ri!"#% -ep%t"e+er

3 US7 ,%! i"pi -%tiPe#erik%%! i!i ,i$+!%k%! +!t+k #e!i%i ,er%%t !ekr"i!%#%i ,%! G*r"i

p%,% k%+ i!=eki kr"!i ,%! ir"i -%ti

4 Pe#erik%%! +!t+k #e!,eteki pe!:e*%* %i! -%ti *i% ,iper+k%! ter#%+k

ke#+!$ki!%! k"&i!=eki -ep%titi ? ,%!%t%+ 'IV

Diagnosis

(' Infeksi he2atitis & akut

.i%$!"% ,ite$%kk%! *er,%%rk%! %!%#!eipe#erik%%! Gi ,%! te#+%!er""$i 'A$ (B) ,%! I$ %!ti&'< (B)

.' Infeksi he2atitis & k"onis

% Kriteri% -ep%titi kr"!i/

i 'A$ er"p"iti= 6 *+%!J

ii Ser+# .NA V' 20000 IU#L !%#+! ,%p%t ,ite#+k%! !i%i :%!$ e*i-

re!,%- 2000&20000 IU#L ,ite#+k%! p%,% k%+ 'eA$ (&)J

iii Pe!i!$k%t%! AL :%!$ perite! #%+p+! i!ter#ite!J

i9 i"pi -%ti :%!$ #e!+!+k%! -ep%titi kr"!i ,e!$%! ,er%%t

!ekr"i!%#%i e,%!$&*er%t

* Kriteri% pe!$i,%p i!%kti=/

i 'A$ er"p"iti9e 6 *+%!J

ii 'eA$ (&) ,%! %!ti&'e (B)J

iii Ser+# AL ,%%# *%t% !"r#%J

RSU. KU.US 2015 P%$e 21


22/41


i9 .NA V' Q 2000 20000 IU#L

9 i"pi -%ti :%!$ ti,%k #e!+!+k%! i!%#%i :%!$ ,"#i!%!


23/41


%$"rit#e ter%pi -ep%titi kr"!i ,i*%$i #e!%,i ,+% :%it+ ke"#p"k p%ie!

,e!$%! 'eA$ p"iti= ,%! 'eA$ !e$%ti= Ke,+%!:% #e#iiki per*e,%%! ,%%# -%

per%%!%! pe!:%kit pr"$!"i ,%! rep"! ter%pi P%,% ke"#p"k 'eA$ p"iti=

ter%pi ,it++k%! %$%r ter%,i er"k"!9eri #e!%,i 'eA$ !e$%ti= .%! p%,%

ke"#p"k 'eA$ !e$%ti= ter%pi ,i*erik%! -i!$$% .NA V' ti,%k ter,eteki %$i

e%#% p%i!$ e,ikit ,+% k%i pe#erik%%! ,%%# e%!$ ;%kt+ e!%# *+%!

7%#*%r 3 A$"rit#% Pe!%t%%k%!%%! 'ep%titi Kr"!i ,e!$%! 'eA$

P"iti=

RSU. KU.US 2015 P%$e 23


24/41


7%#*%r 4 A$"rit#% Pe!%t%%k%!%%! 'ep%titi Kr"!i ,e!$%! 'eA$

Ne$%ti=

RSU. KU.US 2015 P%$e 24


25/41


7%#*%r 5 A$"rit#% Pe!%t%%k%!%%! 'ep%titi Kr"!i ,e!$%! Sir"i

",%it% ter%pi :%!$ tere,i% *er+p% pe$:%te,&i!ter=er"! (pe$&IN) ,%! %!%"$

!+ke"(t)i,% Ke,+%!:% *eker% e*%$%i %!ti9ir+ ek%i$+ i#+!"#",+%t"r

!%#+! #e#iiki ke+!$$+%! ,%! e=ek %#pi!$ :%!$ *er*e,%

Se


26/41


%*e 3 Pr"G re$i#e! O*%t 'ep%titi Kr"!i

Efekti@i

tas

Dosis Resistensi

Peg=Inte"fe"on 30F i,%k %,%Pe$&IN 2% 180 T$#i!$$+ S?

Pe$&IN 2* 1&15T$K$#i!$$+

S?Analog

Nukleos/t0i%a1 A!%"$

N+ke"i,%L%#i9+,i!

(LA)

Q 50F 100 #$-%ri PO 0F (5

t%-+!)e*i9+,i!

(L,)

Q0F 600 #$-%ri PO 22F (2

t%-+!)E!te *%t% %t% !"r#%)

RSU. KU.US 2015 P%$e 26


27/41


Pe#*eri%! i!ter=er"! ,i%k+k%! ,%%# peri",e :%!$ +,%- ,ip%tik%! ,%! ti,%k

ter$%!t+!$ p%,% -%i pe!$"*%t%! k%re!% pe!$%r+- i#+!""$i ,%ri i!ter=er"!

,%p%t #e!et%p ete%- ter%pi ,i-e!tik%! S%%t i!i pe$&IN +#+#!:% ,i*erik%!

e%#% 12 *+%! *%ik +!t+k k%+ 'eA$ p"iti= #%+p+! 'eA$ !e$%ti= Se#e!t%r%

p%,% pe#e*eri%! %!%"$ !+ke"(t)i,% k"!e!+ Ai% P%iGk #erek"#e!,%ik%!

ter%pi p%,% k%+ 'eA$ !e$%ti= ,%! 'eA$ p"iti= *i% k%,%r .NA V' ti,%k

ter,eteki ,e!$%! pe#erik%%! P?R e%#% 3 k%i *ert+r+t&t+r+t ,e!$%! e%!$ 6

*+%!

P"ognosis

I!i,e! k+#+%ti= 5 t%-+! ,%ri %%t ter,i%$!"i -ep%titi kr"!i #e!%,i ir"i

-%ti i%%- 8&20F ,%! i!i,e! k+#+%ti= 5 t%-+! ,%ri ir"i k"#pe!%t% #e!%,i

ir"i ,ek"#pe!%t% p%,% -ep%titi kr"!i :%!$ ti,%k ter"*%ti i%%- 20F P%,%

k"!,ii ir"i ,ek"#pe!%t% tere*+t %!$k% +r9i9% ,%%# 5 t%-+! -%!:% *erki%r

14&35F .i %i! ii ete%- ter%,i ir"i -%ti %!$k% ke%,i%! K'S p%,% -ep%titi

kr"!i i%%- 2&5F



28/41


K6LELITIASIS

De>nisi

K"eiti%i *er%% ,%ri k%t% WcholeX :%!$ %rti!:% %;%%! #e!$e!%i e#pe,+ ,%!

WlithosX :%it+ *%t+ Se


29/41


ter,%p%t ,i !e$%r% %r%t ,%! e+%i ,e!$%! %!$k% ,i !e$%r% tet%!$$% eperti

Si!$%p+r% %%:i% +%!$t-%i ,%! iipi!% '% i!i #e!+!+kk%! *%-;% =%kt"r

i!=eki e#pe,+ "e- k+#%! $r%# !e$%ti= ! "oli ik+t *erper%!%! pe!ti!$ ,%%#

ti#*+!:% *%t+ pi$#e! .i ;i%:%- i!i i!i,e! *%t+ pri#er %+r%! e#pe,+ %,%%-

40&50F ,%ri pe!:%kit *%t+ e#pe,+ e,%!$k%! ,i ,+!i% %r%t ekit%r 5F

Etiologi

Pe!:e*%* ,%! =%kt"r riik" ter*e!t+k!:% *%t+ k%!,+!$ e#pe,+ ti,%k e


30/41


I!t%ke re!,%- k"ri,% ke-i%!$%! *er%t *%,%! :%!$


31/41


,e!$%! e+#%- pr"tei! ,%! k"eter" :%!$ *er9%ri%i %t+ pi$#e! -it%#

+#+#!:% ,i+#p%i p%,% p%ie! ir"i %t%+ pe!:%kit -e#"itik kr"!ik eperti

t%%e#i% ,%! %!e#i% e sickle! %t+ pi$#e!


32/41


Gambar 1. Patogenesis Terjadinya Batu Empedu

Manifestasi Klinik

.%p%t *eri=%t %i#t"#%ti 7e%% #+!


33/41


'i%!$ per%-%! ,e!$%! e!,iri!:%

.iert%i #+% %t%+ #+!t%-

K"ik *iier ,%p%t ,i


34/41


Ke+-%! :%!$ #+!$ki! ti#*+ %,%%- ,ipepi% :%!$ k%,%!$ ,iert%i i!t"er%!

ter-%,%p #%k%!%! *ere#%k P%,% :%!$ i#t"#%ti ke+-%! +t%#% *er+p% !:eri ,i

,%er%- epi$%tri+# k+%,r%! k%!%! %t% %t%+ perik"!,ri+# R%% !:eri %i!!:%

%,%%- k"ik *iier :%!$ #+!$ki! *er%!$+!$ e*i- ,%ri 15 #e!it ,%! k%,%!$ *%r+

#e!$-i%!$ *e*er%p% %# ke#+,i%! i#*+!:% !:eri ke*%!:%k%! per%-%!&%-%!

tet%pi p%,% 30F k%+ ti#*+ ti*%&ti*%

Pe!:e*%r%! !:eri p%,% p+!$$+!$ *%$i%! te!$%- k%p+% %t%+ ke p+!


35/41


:%!$ ti!$$i #+!$ki! ,ie*%*k%! "e- *%t+ ,i ,%%# ,+kt+ k"e,+k+ K%,%r

="=%t%e %k%i er+# ,%! #+!$ki! +$% k%,%r %#i%e er+# *i%%!:% #e!i!$k%t

e,%!$ eti%p eti%p k%i ter%,i er%!$%! %k+t

Pe#erik%%! r%,i""$i

a' "t" p"" %*,"#e!

"t" p"" %*,"#e! *i%%!:% ti,%k #e#*erik%! $%#*%r%! :%!$ k-% k%re!% -%!:%

ekit%r 10&15F *%t+ k%!,+!$ e#pe,+ :%!$ *eri=%t r%,i""p%k K%,%!$ k%!,+!$

e#pe,+ :%!$ #e!$%!,+!$


36/41


,i,eteki k%re!% ter-%%!$ "e- +,%r% ,i ,%%# ++ .e!$%! US7 p+!kt+#

#%ki#+# r%% !:eri p%,% *%t+ k%!,+!$ e#pe,+ :%!$ $%!$$re! e*i- e%

,%rip%,% ,e!$%! p%p%i *i%%


37/41


#%k%!%! *ere#%k ik% *%t+ k%!,+!$ e#pe,+ #e!:e*%*k%! er%!$%! !:eri

*er+%!$ #ekip+! te%- ,i%k+k%! per+*%-%! p"% #%k%! #%k% ,i%!+rk%! +!t+k

#e!%%!i pe!$%!$k%t%! k%!,+!$ e#pe,+ (k"eitekt"#i) Pe!%!$%!%! k"eiti%i

,i*e,%k%! #e!%,i ,+% :%it+ pe!%t%%k%!%%! !"! *e,%- ,%! *e,%- A,% +$%

:%!$ #e#*%$i *er,%%rk%! %,% ti,%k!:% $e%% :%!$ #e!:ert%i k"eiti%i :%it+

pe!%t%%k%!%%! p%,% k"eiti%i i#pt"#%tik ,%! k"eiti%i :%!$ %i#pt"#%tik

Pe!%t%%k%!%%! N"!&e,%-

P%,% "r%!$ ,e;%% %ter!%ti= ter%pi !"! *e,%- #eip+ti pe!$-%!


38/41


&tracorporeal .hock/ave 0ithotripsy (ESHL) #e!$$+!%k%! $e"#*%!$ +%r%

,e!$%! %#pit+," ti!$$i +!t+k #e!$-%!


39/41


ke#%ti%! ,i*%!,i!$ "per%i !"r#% (01&05F +!t+k "per%i !"r#%) ,e!$%!

#e!$+r%!$i k"#pik%i p%,% %!t+!$ ,%! p%r+ K%!,+!$ e#pe,+ ,i%!$k%t

#e%+i e%!$ :%!$ ,i#%+kk%! e;%t %:%t%! ke


40/41


#+k"ke ,%p%t #e!%,i +%t+ e#pie#% *i%%!:% k%!,+!$ e#pe,+ ,ikeii!$i ,%!

,it+t+pi "e- k""! ,%! ,%p%t +$% #e#*e!t+k +%t+ Gte k"eit",+",e!%

Pe!:+#*%t%! ,+kt+ itik+ ,%p%t +$% *er%ki*%t ter%,i!:% k"eititi %k+t :%!$

,%p%t e#*+- %t%+ ,%p%t #e!$%ki*%tk%! !ekr"i e*%$i%! ,i!,i!$ (,%p%t ,it+t+pi

%%t ekit%r!:%) ,%! ,%p%t #e#*e!t+k +%t+ Gte k"eit",+",e!% %t%+p+! ,%p%t

ter%,i per="r%i k%!,+!$ e#pe,+ :%!$ *er%ki*%t ter%,i!:% perit"!iti

$e!er%i%t%

%t+ k%!,+!$ e#pe,+ ,%p%t #%+ #%+k ke ,%%# ,+kt+ itik+ p%,% %%t

k"!tr%ki ,%ri k%!,+!$ e#pe,+ %t+ i!i ,%p%t ter+ #%+ %#p%i ,+kt+ k"e,"k+

ke#+,i%! #e!et%p %i#t"#%ti %t%+ k%,%!$ ,%p%t #e!:e*%*k%! k"ik %t+ :%!$

#e!:+#*%t ,i ,+kt+ k"e,"k+ +$% *er%ki*%t ter%,i!:% k"%!$iti k"%!$i"iti

,%! p%!kretiti%t+ k%!,+!$ e#pe,+ ,%p%t "" ke ,%%# %+r%!


41/41


DAFTAR PUSTAKA

1 Per-i#p+!%! Pe!eiti '%ti I!,"!ei% (PP'I) K"!e!+ !%i"!%

pe!%t%%k%!%%! -ep%titi ,i I!,"!ei% %k%rt%/ PP'IJ 20122 Li%; Y K%" ' Pir%t9i+t- ?-%! 'L ?-ie! RN Li+ ? ,kk Ai%!&P%

case evelyn - dr. idil

Documents