D
)0
50
B !00 E D 43,33 E 8%or+o2eight D 400!00E:
Kesa% : normoweight pada ascites
4. Kulit : Far%a sa2o +ata%g, pte"hie 80:, i"teri" 80:, turgor
<u"up 80:, hiperpig+e%tasi 80:, "ulit "eri%g pada "edua
"a"i 80:, "ulit seperti 3era+i 80:
5. Kepala : &e%tu" +eso<ephal, ra+7ut 2ar%a hita+ de%ga% sedi"it
u7a%, +udah ro%to" 80:, alopesia 80:, lu"a 80:
). ata : onjuncti!a pucat (+"+), sclera ikterik (+"+),
perdaraha% su7<o%3u%<ti>a 80(0:, pupil iso"or de%ga%
dia+eter 3 ++(3 ++, re#leB <ahaya 89(9:, ede+a
palpe7ra 80(0:, stra7is+us 80(0:, ar<us se%ilis 80(0:, s<lera
+utiara 80(0:
5. $eli%ga : +e+7ra% ti+pa%i i%ta" 89(9:, se"ret 80(0:, darah 80(0:,
%yeri te"a% +astoid 80(0:, %yeri te"a% tragus 80:
5
4. Hidu%g : %a#as <upi%g hidu%g 80:, de>iasi septu+ %asi 80:, se"ret
80:, epista"sis 80:, #u%gsi pe%ghidu 7ai".
*. ulut : +u"osa 7asah 80:, sia%osis 80:, gusi 7erdarah 80:, "eri%g
80:, pu<at 80:, lidah ti#oid 80:, lidah tre+or 80:, papil lidah
atro#i 80:, sto+atitis 80:, lu"a pada sudut 7i7ir 80:
!0. /eher : .AP 69' <+, tra"ea leta" dite%gah, si+etris,
pe+7esara% tiroid 80:, pe+7esara% li+#o%odi ser>i"al 80:.
!!. $horaB : 7e%tu" %or+o<hest, si+etris, retra"si i%ter <osta 80:,
spider %e>i 80:, per%a#asa% thora"oa7do+i%al, sela iga
+ele7ar 80:, pe+7esara% KG& aBial 80:.
#antung $
,%spe"si : ,<tus <ordis tida" ta+pa"
Palpasi : ,<tus <ordis tida" "uat a%g"at
Per"usi : &atas 3a%tu%g "a%a% atas : S,1 ,, li%ea paraster%al
"a%a%
&atas 3a%tu%g "a%a% 7a2ah: S,1 ,A li%ea paraster%al
"a%a%
&atas 3a%tu%g "iri atas : S,1 ,, li%ea paraster%al "iri
&atas 3a%tu%g "iri 7a2ah : S,1 ,A ! <+ +edial /1S
Kesa% : &atas 3a%tu%g tida" +ele7ar
Aus"ultasi : H6 55 "ali(+e%it, regular, 7u%yi 3a%tu%g ,0,, i%te%sitas
%or+al, regular, 7isi%g 80:
%ulmo $
Depa%
,%spe"si Statis : Nor+o<hest, si+etris, sela iga tida"
+ele7ar
Di%a+is : Pe%ge+7a%ga% dada si+etris "a%a% D "iri,
sela iga tida" +ele7ar, retra"si i%ter<osta 80 :
Palpasi Statis : Si+etris
Di%a+is : Pergera"a% dada "a%a% D "iri, pe%a%3a"a%
dada "a%a% D "iri, #re+itus ra7a "a%a% D "iri
4
Per"usi Ka%a% : So%or, +ulai redup pada 7atas paru0hepar
&atas relati>e paru hepar di S,1 A li%ea
+edio<la>i<ularis deBtra
&atas a7solute paru hepar pada S,1 A, li%ea
+edio<la>i<ularis deBtra
Kiri : so%or hi%gga 7atas paru0la+7u%g di S,1
A, li%ea +edio<la>i<ularis si%istra
Aus"ultasi : Suara dasar paru "a%a% "iri >esi"uler %or+al, Suara
ta+7aha% 80(0:
&ela"a%g
,%spe"si Statis : Nor+o<hest, si+etris, sela iga tida"
+ele7ar
Di%a+is : Pe%ge+7a%ga% dada si+etris "a%a% D "iri,
sela iga tida" +ele7ar, retra"si i%ter<osta 80:
Palpasi Statis : Si+etris
Di%a+is : Pergera"a% dada "a%a% D "iri, pe%a%3a"a%
dada "a%a% D "iri, #re+itus ra7a "a%a% D "iri
Per"usi : Paru "a%a% so%or, paru "iri so%or
Aus"ultasi : Suara dasar paru "a%a% "iri >esi"uler %or+al, Suara
ta+7aha% 80(0:
!'. Pu%ggu%g : Ki#osis 80: %or+al, /ordosis 80: %or+al, s"oliosis 80:,
%yeri "eto" "osto>erte7ra 80:,
!3. A7do+e%
,%spe"si : Di%di%g perut le7ih ti%ggi dari di%di%g thora"s,
distended(+), !enektasi (+), spider ne!i (+), si"atri"s
80:, striae al7a 80:, <aput +eduse 80:
Aus"ultasi : Peristalti" 89: %or+al
Per"usi : %ekak alih (+), pekak sisi (+), undulasi (+)
Palpasi : Supel, nyeri tekan (+) pada ulu hati dan perut kanan
atas, hepar da% sulit die>aluasi.
!4. Ge%itouri%aria : -l"us 80:, se"ret 80:, ta%da0ta%da rada%g 80:
*
!5. ?"stre+itas
Superior de"stra : ?de+a 80:, "a"u 80:, pu<at 80:, a"ral di%gi% 80:, lu"a 80:,
de#or+itas 80:, i"teri" 80:, pte"hie 80:, spoon nail (+),
"u"u pu<at 80:, <lu77i%g #i%ger 80:, palmar eritem (+),
seperti "ulit 3era+i 80:
,%#erior de"stra : ?de+a 80:, "a"u 80:, pu<at 80:, a"ral di%gi% 80:, lu"a 80:,
de#or+itas 80:, i"teri" 80:, pte"hie 80:, spoon nail(+),
"u"u pu<at 80:, <lu77i%g #i%ger 80:, hiperpig+e%tasi 80:,
seperti "ulit 3era+i 80:
Superior si%istra : ?de+a 80:, "a"u 80:, pu<at 80:, a"ral di%gi% 80:, lu"a 80:,
de#or+itas 80:, i"teri" 80:, pte"hie 80:, spoon nail (+),
"u"u pu<at 80:, <lu77i%g #i%ger 80:, palmar eritem (+),
seperti "ulit 3era+i 80:
,%#erior si%istra : ?de+a 80:, "a"u 80:, pu<at 80:, a"ral di%gi% 80:, lu"a 80:,
de#or+itas 80:, i"teri" 80:, pte"hie 80:, spoon nail(+),
"u"u pu<at 80:, <lu77i%g #i%ger 80:, hiperpig+e%tasi 80:,
seperti "ulit 3era+i 80:
!). Kele%3ar getah 7e%i%g i%gui%al tida" +e+7esar
!0
C" PEMERIKSAAN PENUN9ANG
L)b81)(81i,m
$%!4!%& $1!4!%& $$!4!%&
S)(,)n
Ni+)i
R,:,0)n
H7
3,4 4,% 5,%
gr(dl
/" : !3,50!4,0
Pr : !',00!),0
S, 33 0 !0'
$,&1 ''4 0 4'4
H<t
11,3 1& $$
E
/" : 40054
Pr: 34045
A? 1,43 2,4 $,5%
!0
)
(-l
/" : 4,)0),'
Pr : 4,'05,4
A/
4,) ',44
!0
3
(-l
4,50!!
A$ 132 35 2%
!0
3
(-l !500440
6eti"ulosit !,00 E 0.50!.5
P$ Deti" !0 G !5
AP$$ Deti" '0 G 40
,N6 Deti"
/?D! 3a+ ++(3a+ 0 G '0
/?D' 3a+ ++(3a+ 0 G '0
AS$O ,-(+l H'00
1A 55,7 Il 400*5
1H $2,7 Pg '503!,'
1H1 3!,* gr(dl 3!,4035,4
6DF 1&,% E !!.) G !4.)
HDF 4,% g(d/ '.' G 3.'
PA !0,! #l 5.' G !!.!
PDF 4' E '5 G )5
?osi%o#il 1,1% E ' G 4
&aso#il 0,!0 E 0 G !
Netro#il 73,2% E 53 G 55
/i+#osit 1%,4% E '5 G 40
o%osit ',40 E ' G 4
/-1 ',00
GDS $33 +g(dl 400!!0
GDP $15 +g(dl )0 G !00
GD'PP +g(dl 40 G !40
Gol. Drh
&
-reu+ 50 +g(dl !0050
Kreati%i% 0,* +g(dl 0,50!,3
Na !3) !35 ++ol(/ !3) G !4)
K 3,1 3,$ ++ol(l 3.5 G 5.!
1l !0) !05 ++ol(/ *4 G !0)
,o% 1a ++ol(/ !.00 G !.'0
Prot total 4,1% 4,1% g(dl ),)04,5
Al7u+i% $,3 $,2 g(dl 3,505
Glo7uli% 3,5 g(dl 0,)05,'
&il. $otal 4,43 +g(dl 00!,!
&il dire" 3,%5 +g (dl 000,'5
&il. ,%dire" +g (dl 000,55
SGO$ 30 u(/ 0034
SGP$ 3' u(/ 004!
J G$ '! u(/ H 34
Al"ali
#os#atase
45
u(/ H '40
Asa+ -rat 4,) +g(dl 3,405,0
Kolesterol
total
45
+g (dl 500'00
!!
HD/0D 4' +g (dl 4!0)5
/D/0D 50 +g (dl 00!30
$rigliserid 50 +g (dl 500!50
Ierriti% %g(+l !00!44
Ii7ri%oge% '000400
H7sAg 9
-ri%alisa $$!%4 Satua% Nilai 6u3u"a%
a"ros"opis
Far%a "u%i%g
Ke3er%iha% <laudy
Ki+ia -ri%
&erat .e%is !,0' !,0!50!,0'5
pH 5,0 4,504,0
/eu"osit 1%% (-l %egati#
Nitrit ; %egati#
Protei% $3 +g(dl %egati#
Glu"osa %or+al +g(dl %or+al
Keto% 3 +g(dl %egati#
-ro7ili%oge% 2 +g(dl %or+al
&iliru7i% 3 +g(dl %egati#
?ritrosit 0 (-l Negati#
i"ros"opis
?ritrosit 0 (/P& 00!
/eu"osit 30) (/P& 304
?pitel
?pitel SKua+ous '04 (/PK
?pitel tra%sisio%al 0 (/PK Negati#
?pitel 7ulat 0 (/PK Negati#
Sili%der
Hyali% 0 (/PK 003
Gra%ulated 00! (/PK Negati#
/e"osit 0 (/PK Negati#
Kristal 0 (/P& Negati#
/ai%0lai%
&e%a%g +u"us
&a"teri ;
USG Ab'8men < $3 9,ni $%%& =
e%yo"o%g ga+7ara% sirosis hepati< de%ga% portal hiperte%si, as<ites per+ag%a da%
sple%o+egali.
G)mb)1)n D)1)- Te>i < $3 9,ni $%%& =
?ritrosit : Hipo"ro+, a%isositosis, poi"ilositosis, +i"rositi", pe%<il <ell 89:, target <ell
89:, leptosit 89:, 7asophili< stippli%g89:, s<hi@to<yte 89:, poli"ro+asi 89:, eritro7las 89:.
/eu"osit : .u+lah dala+ 7atas %or+al, hipergra%ulasi %atro#il 89:, sel +uda 80:.
$ro+7osit : 3u+lah +e%uru%, gia%t tro+7asit 89:
Si+pula% : a%e+ia hipo"ro+ +i"rositi" de%ga% tro+7ositope%ia. Suspe<t : proses
"ro%is de## Ie 7ersa+aa% proses i%#e"si(proses he+oliti".
!'
Sara% : SP?, S,($,&1,16P, 6eti"ulosit.
D" RESUME
Se3a" 3 hari S6S pasie% +erasa %ggliyer, %ggliyer dirasa"a% terus0+e%erus,
%ggliyer dirasa"a% saat peru7aha% posisi dari dudu" "e 7erdiri. ata 7er"u%a%g0"u%a%g
89:, teli%ga 7erde%gi%g 89:, sulit u%tu" +e%ela% 89:. Na#su +a"a% +e%uru% 89:, +ual 89:.
Nyeri perut 89: pada perut "a%a% atas, %yeri ya%g dirasa"a% seperti dire+as0re+as, tida"
7er"ura%g de%ga% pe+7eria% +a"a%a%. Pasie% +erasa perut%ya +a"i% +e+7esar, dii"uti
rasa se7ah 89: da% sesa" 89:. Se7ah ya%g dirasa"a% se+a"i% +e+7erat "eti"a di7eri
+a"a%a% atau +i%u+a%. Setiap +a"a% 405 se%do" +a"a%, pasie% +erasa "e%ya%g da%
se7ah. Ke+7u%g 89:, tapi +asih 7isa "e%tut. ata "u%i%g 89:. &AK 2ar%a seperti teh,
sehari 304 "ali, 3u+lah ; 3(4 gelas 7eli+7i%g, susah "eluar da% %yeri pada per+ulaa%
89:, a%ya%g0a%ya%ga% 89: da% +e%ghila%g "eti"a selesai &AK pa%as saat "e%<i%g 89:.
Satu +i%ggu S6S, pasie% ti7a0ti7a +u%tah darah ! "ali, 2ar%a darah +erah tua,
se7a%ya" = gelas 7eli+7i%g, "o%siste%si "e%tal da% tida" disertai +a"a%a%. ual 89:
se7elu+ da% sesudah +a"a%. Na#su +a"a% +e%uru%.
$iga tahu% S6S, pasie% +e%geluh"a% %yeri perut ulu hati da% "a%a% atas, %yeri
seperti dire+as0re+as. Pasie% +e%g"o%su+si o7at +aag ya%g di7eli di apote", "ura%g
le7ih satu +i%ggu se"ali. Pasie% +erasa "eluha% tida" 7er"ura%g. Pasie% 3uga +erasa"a%
7erat 7ada% ya%g +e%uru%.
Pe+eri"saa% #isi", gi@i "esa% "ura%g, "o%3u%gti>a pu<at 89(9:, s"lera i"teri" 89(
9:, di%di%g perut diste%ded 89:, >e%e"tasi 89:, spider %e>i 89:, pe"a" alih 89:, pe"a" sisi
89:, u%dulasi 89:, %yeri te"a% pada ulu hati 89:. ?"stre+itas superior de"stra da% si%istra
pal+ar erite+ 89:. Kee+pat e"stre+itas spoo% %ail 89:.
Pe+eri"saa% la7oratoriu+ : H7 ta%ggal '5(5(0* 3,) gra+(d/, H<t ta%ggal '5(5(0*
!!,5 E, ?ritrosit ta%ggal '5(5(0* !,)5.!0
)
(-l, $ro+7osit ta%ggal '5(5(0* !34 .!0
)
, 1A
ta%ggal '5(5(0* 55,4 Il, 1A ta%ggal '5(5(0* '4,4 Pg. ?osi%o#il ta%ggal '5(5(0* !,!0 E,
Netro#il ta%ggal '5(5(0* 43,40 E, li+#osit ta%ggal '5(5(0* !0,)0 E. GDS ta%ggal '5(5(0*
'55 +g(dl, GDP ta%ggal '5(5(0* '!5 +g(dl. Kaliu+ ta%ggal '5(5(0* 3,! ++ol(/. Protei%
total ta%ggal '5(5(0* ),!0 g(dl, Al7u+i% ta%ggal '5(5(0* ',5 g(dl. &iliru7i% total ta%ggal
'5(5(0* ),)3 +g(dl, &iliru7i% dire" ta%ggal '5(5(0* 3,05 +g(dl. H7sAg ta%ggal '5(5(0*
!3
89:. -ri%alisa ta%ggal '4(5(0* +a"ros"opis : leu"osit !00 -/, %itrit 89:, protei% '5
+g(d/, "eto% 5 +g(d/, uro7ili%oge% 4 +g(d/, 7iliru7i% 3 +g(d/, 7a"teri 89:.
-SG A7do+e% ta%ggal 30 ei '00* e%yo"o%g ga+7ara% sirosis hepati<
de%ga% portal hiperte%si, as<ites per+ag%a da% sple%o+egali.Ga+7ara% darah tepi
ta%ggal '* ei '00* a%e+ia hipo"ro+ +i"rositi" de%ga% tro+7ositope%ia. Suspe<t :
proses "ro%is de## Ie 7ersa+aa% proses i%#e"si(proses he+oliti"
E" DAFTAR ABNORMALITAS
!. Nggliyer
'. ata 7er"u%a%g0
"u%a%g
3. $eli%ga
7erde%gi%g
4. Sulit u%tu"
+e%ela%
5. Na#su +a"a%
+e%uru%
). ual
5. Nyeri perut "a%a%
atas
4. Perut +a"i%
+e+7esar
*. Se7ah
!0. Ke+7u%g
!!. Sesa"
!'. ata "u%i%g
!3. &AK 2ar%a
seperti teh
!4. &AK susah "eluar
!5. Nyeri a2al &AK
!). A%ya%g0a%ya%ga%
!5. Pa%as saat &AK
!4. u%tah darah
!*. &erat 7ada%
+e%uru%
'0. .i+pe03i+pe
'!. Ko%3u%gti>a pu<at
''. S"lera i"teri"
'3. Di%di%g perut
diste%ded
'4. Ae%e"tasi 89:
'5. Spider %e>i 89:
'). Pe"a" alih 89:
'5. Pe"a" sisi 89:
'4. -%dulasi 89:
'*. Nyeri te"a% pada ulu hati da% "a%a% atas
30. ?"stre+itas superior de"stra da% si%istra pal+ar erite+ 89:
3!. ?"stre+itas spoo% %ail 89:
3'. H7 3,) gra+(d/, ),0 gra+(d/, 5,0 gra+(d/
!4
33. H<t !!,5 E, !*E, ''E
34. ?ritrosit !,)5.!0
)
(-/, 4,).!0
)
(-/, ',5.!0
)
(-/
35. $ro+7osit !34 .!0
)
(-/, 35.!0
)
(-/, 40.!0
)
(-/
3). 1A 55,4 Il
35. 1H '4,4 Pg
34. ?osi%o#il !,!0 E
3*. Netro#il 43,40 E
40. /i+#osit !0,)0 E
4!. GDS '55 +g(dl
4'. GDP '!5 +g(dl
43. Kaliu+ 3,! ++ol(/
44. Protei% total ),!0 g(dl
45. Al7u+i% ',5 g(dl
4). &iliru7i% total ),)3 +g(dl
45. &iliru7i% dire" 3,05 +g(dl
44. H7sAg 89:
4*. -ri%alisa leu"osit !00 -/, %itrit 89:,7a"teri 89:.
50. -ri%alisa protei% '5 +g(d/
5!. -ri%alisa "eto% 5 +g(d/, uro7ili%oge% 4 +g(d/, 7iliru7i% 3 +g(d/
5'. -SG A7do+e% e%yo"o%g ga+7ara% sirosis hepati" de%ga%
portal hiperte%si, as<ites per+ag%a da% sple%o+egali
53. Ga+7ara% darah tepi a%e+ia hipo"ro+ +i"rositi" de%ga%
tro+7ositope%ia. Suspe<t : proses "ro%is de## Ie 7ersa+aa% proses i%#e"si(proses
he+oliti"
F" ANALISIS DAN SINTESIS
!. A7%or+alitas
5,),5,4,*,!0,!!,!',!3,!4,!*,'','3,'4,'5,'),'5,'4,'*,30,35,44,45,4),45,5' sirosis
hepatis
!5
'. A7%or+alitas !,',3,4,'0,'!,3!,3',33,34,3),35,53 a%e+ia hipo"ro+
+i"rositi"
3. A7%or+alitas !4,!5,!),!5,34,3*,40,4*,50,5! Kli%is ,SK
4. A7%or+alitas 4!,4' hipergli"e+i
5. A7%or+alitas 44 Hepatitis &
). A7%or+alitas 43 hipo"ale+i
G" PROBLEM
!. Sirosis hepatis
'. A%e+ia hipo"ro+ +i"rositi"
3. Kli%is ,SK
4. Hipergli"e+i
5. Hepatitis &
). Hipo"ale+i
H" RENCANA PEMECAHAN
MASALAH
P18b+em 1" Si18*i* -e>)(i*
Ass : "o+pli"asi
,p DB : 7iopsi hati, e>aluasi <aira% as<ites, e>aluasi "adar ele"trolit
darah(uri%
,p $B : &edrest tida" total
Diet hepar !500 ""al da% re%dah gara+, 7atasi asupa% <aira%
,%#. Na1l 0,*E '0 tp+
,%3. Propa%olol 'B5 +g
,%3. 6a%itidi% ! a+p(!' 3a+
A%tasid syr 3 B 1 ,
1ur<u+a 3B!
Spiro%ola"to%e!00+g !0!00
Iurose+id 40 +g !0!00
,p B : o%itor K-AS
,p ?B : Pe%3elasa% te%ta%g pe%ya"it%ya da% "o+pli"asi%ya
!)
Prog%osis : Ad >ita+ : du7ia ad +ala+
Ad sa%a+ : du7ia ad +ala+
Ad #u%gsio%a+ : du7ia ad +ala+
P18b+em $" Anemi) -i>8018m mi018*i(i0
Ass : etiologi dd. Perdaraha%
dd. pe%ya"it "ro%is
dd. De##. Ie
,p DB : Ieses ruti%, S,,$,&1, Ieriti%, SP?, 16P, 6eti"ulosit
,p $B : $ra%s#usi ' "ol#(hari sa+pai H7 L !0 g(d/
,p B : A2asi ta%da perdaraha%
,p ?B : Pe%3elasa% te%ta%g pe%ya"it%ya da% "o+pli"asi%ya
Prog%osis : Ad >ita+ : du7ia ad 7o%a+
Ad sa%a+ : du7ia ad 7o%a+
Ad #u%gsio%a+ : du7ia ad 7o%a+
P18b+em 3" K+ini* ISK
Ass : etiologi dd. stri"tur
dd. &SK
,p DB : Kultur uri% da% se%si>itas a%ti7ioti", -SG , &NO, ,AP,
,p $B : ,%3. 1e#tria"so% ! a+p(!' 3a+
,p B : -ri% ruti%
,p ?B : Pe%3elasa% te%ta%g pe%ya"it%ya da% "o+pli"asi%ya, +e%3aga
"e7ersiha% a%al da% ge%ital
Prog%osis : Ad >ita+ : du7ia ad 7o%a+
Ad sa%a+ : du7ia ad 7o%a+
Ad #u%gsio%a+ : du7ia ad 7o%a+
P18b+em 2" He>)(i(i* B
Ass :0
!5
,p DB : 0
,p $B : 0
,p B : 0
,p ?B : Pe%3elasa% te%ta%g pe%ya"it%ya da% "o+pli"asi%ya
Prog%osis : Ad >ita+ : du7ia ad 7o%a+
Ad sa%a+ : du7ia ad 7o%a+
Ad #u%gsio%a+ : du7ia ad 7o%a+
P18b+em 3" Hi>e1g+i0emi)
Ass : etiologi dd rea"ti#
dd D tipe ,,
,p DB : GDS da% GDP ula%g, GD'PP, $$GO
,p $B : Diet D
,p B : 0
,p ?B : Pe%3elasa% te%ta%g pe%ya"it%ya da% "o+pli"asi%ya
Prog%osis : Ad >ita+ : du7ia ad 7o%a+
Ad sa%a+ : du7ia ad 7o%a+
Ad #u%gsio%a+ : du7ia ad 7o%a+
P18b+em 4" Hi>80)+emi
Ass : etiologi dd i%ta"e "ura%g
dd e"s"resi +e%i%g"at
,p DB : ?KG, <e" "aliu+ seru+ ula%g
,p $B : KS6 ta7 3 B !
,p B : <e" "aliu+ seru+ ula%g
,p ?B : Pe%3elasa% te%ta%g pe%ya"it%ya da% "o+pli"asi%ya.
e%ga%3ur"a% +a"a% +a"a%a% "aya "aliu+ 8 7uah,dagi%g,susu
da% "a<a%g0"a<a%ga% :
Prog%osis : Ad >ita+ : du7ia ad 7o%a+
Ad sa%a+ : du7ia ad 7o%a+
Ad #u%gsio%a+ : du7ia ad 7o%a+
!4