Anda di halaman 1dari 26

PRESENTASI KASUS

HEMOROID

Pembimbing:

Dr. Eka Swabhawa Uttama, SpB

Oleh:

Labiqotul Lubabah Ahasmi

106103003449

KEPANITERAAN KLINIK ILMU BEDAH RUMAH SAKIT UMUM PUSAT FATMAWATI

PROGRAM STUDI PENDIDIKAN DOKTER

FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN

UNIVERSITAS ISLAM NEGERI SYARIF HIDAYATULLAH

JAKARTA

2010

c
c
LEMBAR PENGESAHAN

à   c c  c

  c
 c c c  c c  cc
  c  c  c   c  cc c cc
cc   c cc ! c"#"c$c%c  c"##c
c
c
c
c
c
c
   c& c"#"c
c
c
c
c
'(c) c   c c*+c
c
c
c
c
c
c
c
c
c
c
c

c
c
KATA PENGANTAR


,   c c-  c c  c c   c  c, c.c
 c    c    c   c  c     c  c  c   c
  c   c c  c  (c    c  c   c   c  c
/   c  c   c c cà  c,.(c

,  c   c   c c   c    (c &  c    c   c c


 c c /   c  c c c  c c (c c c
 c   c c  c c  c (c

 c  /  c  c  c   c (c ) c    c  c *c


  c   c   c  c   c  c  c  c    c   c
   c   c(c

   cc& cc"#"c

cccccccccc c

c
c
DAFTAR ISI

LEMBAR PENGESAHAN ...................................................................................... ii

KATA PENGANTAR .............................................................................................. iii

DAFTAR ISI ........................................................................................................... iv

BAB I ILUSTRASI KASUS

A. IDENTITAS PASIEN ......................................................................................... 1


B. ANAMNESIS ..................................................................................................... 1
C. PEMERIKSAAN FISIK ...................................................................................... 3
D. PEMERIKSAAN PENUNJANG ........................................................................ 5
E. RESUME ........................................................................................................... 5
F. DIAGNOSIS ...................................................................................................... 5
G. DIAGNOSIS BANDING .................................................................................... 6
H. PEMERIKSAAN ANJURAN ............................................................................. 6
I. PENATALAKSANAAN ..................................................................................... 6
J. PROGNOSIS .................................................................................................... 6

BAB II TINJAUAN PUSTAKA

A. PENDAHULUAN............................................................................................... 7
B. ANATOMI DAN FISIOLOGI ANOREKTAL ...................................................... 7
C. DEFINISI HEMOROID ...................................................................................... 11
D. PATHOGENESIS .............................................................................................. 12
E. KLASIFIKASI DAN DERAJAT ......................................................................... 12
F. GEJALA DAN TANDA ..................................................................................... 13
G. PEMERIKSAAN ................................................................................................ 14
H. DIAGNOSIS BANDING .................................................................................... 14
I. TATALAKSANA ............................................................................................... 15

BAB III ANALISIS KASUS ..................................................................................... 20

DAFTAR PUSTAKA............................................................................................... 22

c
c
BAB I

ILUSTRASI KASUS

A. IDENTITAS PASIEN
(càc c c 0c"#"11"#"c
c c c 0c(c2/c c
 c c c 0c1c  c
c3 c c 0c4 5 c
, c c c 0c6 c
, c c c 0c c  c c*c#c (ccc""7"8c  c
  c  c* c
 c c 0c,  7 ! c
 c c 0c  cc
  c  c 0c3 c
  cà  cc 0c#9c& c"#"cc c c c
c
B. ANAMNESIS
&   c   c  c  c#9c& c"#"cc c c (c
1. Keluhan Utama
*  cc  c c  c c1c cà(cc
2. Keluhan Tambahan
* c c c c  (c
3. Riwayat Penyakit Sekarang
 c   c  c   c   c c  c  c  c  c 1c
 c à(c *  c  c   c  c  c  c  c c  c    c
 c c:c  c c  c c   c  c c  c  c
  c /  c   c  c  c  c  c c  c   c
 c #c   c  c   c  c  c   c  c  c  c c  c  c
 c   c  c   c  c   c  c   c   c  c
/  c   c  c    c  c  c  (c *  c   c   c
 c  c  c  c c  c   c  c  c 1c  c àc   c

c
c
 c  c c  c  c  c  c   c  c   c    c
 c  c c c (c
 c    c  c c  c   c  c  c   c  c  (c
 c  c  c c  c   c  c   (c &  c   c  c  c
 c  c /  c  c ;(c à  c  c   c  c  c   c
  c c c c  c  c c c c c   c
  c   c  c  c  c  c  c c  (c  c 1c  c  c
   c  c c 5  c c  c  c  c   c
  c c c c  c / 7(c
) c  c c  c c c / c c c (c c c
c  c c  c  (c  c  c c  c  c   c   c   c
 c  c  c c  c  c   c  c  c     c
  c c#c cc.2c  c c c (cc
 c  c   c c  c  c  c    c   c
  c   c  c  c  c c  c   c   c  (c  c   c
   c   c   c c c  c c  c
      (cc
 c  c  c   c    c   c  c c  c c
 c c c  c/ c c; c  c c(c&  c c
 c  c  c c  c  c  c (c  c  c   c   c
c c c  (c
* c c/c  c c c  c   c  c cc c
 cc c (c
 c   c  c c   c  c   c   c c  (c  c
 c    c   c   c c  c ; c  c c  c c
  c   (c
c
4. Riwayat Penyakit Dahulu
  c c!c  cc c/c c  c c (c
 c c   c   c c  c  c   (cc
c

c
c
5. Riwayat Penyakit Keluarga
 c  c   c  c c c  c  c c c
c (cc
  c  cc/c c c c  c  c
  c c (c
6. Riwayat Kebiasaan
 c    c   c  c  c   c   c   5
   c c 5  (c c c   c    c c c:c
  c  c   c  c  c  c   c   5   c  c  5
  (c c c  c c  c   c  c c (c c
  c    c   c  c  c   c  c    c  c
 c  c  c#c c c1c c c c c c:c  c c
  c c  c#c c c:5<c c c (c
 c    c  c  c    c  c c c  c
   (c,! c c 5 c  c  cc  c  (cc
 c c c    c   cc  (c
c
C. PEMERIKSAAN FISIK
1. STATUS GENERALIS
a. Keadaan Umum :   c c 
b. Kesadaran : 3  c 
c. Tekanan Darah : ##"7<"c 
d. Frekuensi Napas : "c=7 
e. Frekuensi Nadi : <%c=7 
f. Suhu : 1<9"2
g. Kepala
 ; c  c c c   c c  c/  (
h. Mata
3  ! c  c>7>c/ cc575
i. Hidung
  c/c575c c575

c
c
ÿ. Telinga
  c/c575
k. Mulut
÷   c; c c (
l. Leher
  c  cc (
m. Thoraks
Paru
6c 0c  c  c c c c c c
  c 0c! / c;  c  c cc c  c  (c
 c 0c  cc c  c  c
,   0c  c  c! c c575c?c575c
Jantung
6c 0c c c c  c
  cc 0c c c  cc62c@c c / !/  c c
 c 0c
c *  c  c  0c62c6@c c   c c
*  c  cc 0c62c@c c / !/  c cc
 c  c 0c62c666c c   c c c
,   c0c c  c6c66c  c  c'5+c
'5+c
n. Abdomen
6c 0c&  c
  c 0c cc c'5+c
 c 0c  cc  c  c  c
,   c0c*c  c'>+c
o. Ekstremitas
, c  c c'5+c
c
c
c

c
c
2. SATUS LOKALIS
 c  cc
6c0c  c c c1c  c  c c  c  c   c
c c  c c   cc=cc=cc/ (cc
  c0cc c'5+c c c  c  (c
c
D. PEMERIKSAAN PENUNJANG
* c   c  (c
c
E. RESUME
c  c  5 c  c 1c   c   c  c   c   c c  c
 c  c c1c cà(c*  cc  c  c   c c c:c
  c c  c  c   c  c c c*,*c c  c  c c
 c *,*(c   c   c  c   c   c  c  c  c *,*c  c   c
 c   c  c   c  c   c #c  (c  c  c  c  c   c
 c   c    c    c  c   c  (c  c   c    c
*,*c   c   c  c  c  c /  c ;c  c  c c  c
 c(c*,3c  c  c  cc c'5+c  c'5+(c
c  c    c   c  c   c  c  c   c     c
 c    c ! c ;(c  c  c  c    c    c c
  (c

c   c ;c    c   c  c    c   ! c  c


 c &c ##"7<"c (c   c   c   c  c   c   c
  c   (c   c  c  c    c 6c 0c   c  c  c 1c   c
  c c  c  cc   cc c  c c   cc=cc
=cc/ (c  c0cc c'5+c c c  c  (cc

F. DIAGNOSIS
  c c c6@c
G. DIAGNOSIS BANDING
c

c
c
H. PEMERIKSAAN ANJURAN
  c  c cc
c
I. PENATALAKSANAAN
Medikamentosa
  cc
@c3c
4 = cc
   cc
Non medikamentosa
*  c  c   c c
*  c  c c c
*  c    c
J. PROGNOSIS
,c! c c 0c*  cc
,c   c 0c  c c  c
,c    c 0c  c c  c

c
c
BAB II

TINJAUAN PUSTAKA

A. Pendahuluan

  c    c c  c  c c/  c  c  c  c


 c c 5 (c&c2àc cc  c'  c#AA1c(c& c#AA8+c
 c 8#8c  c   c     c    c #"%c ':"AB+c   c   (c
  c  c   c  c c  c  c 
 
      c
 cc    c (c3  c cc   c 0c c c c c c
 c   c   c   c  c   c   c c   c    c   c   c
 c  5 (c  c   c   c   c   c c   5  c  c  c  c
 c  c  c 5 c c   c    c c   c  c  c
  c   c   (c   c  c ;  c  c /  c   c
  c 0c  c  cc  c c  c/  c c c c c
 c  c   c  c   c   c  c ;  c  c   c
 c  c   c   c   c  c  c ' c  c
 c  +c  c  c  (c      c   c  c  c      c
/  c /c c/  c c  c  c   (#c

B. Anatomi Dan Fisiologi Anorektal

c 3  c  c   c  c    c  c    c !  c /  c
  c/ c  c c  (c3  c c  c  c c/ cc
 c    c   ; c  c   c ! c  c  ; c  c   c
  c   c c  c    (c / c  c c   c   c  c
  c   c  c c   c  c    c    c c  c
c  c  (c  c  c  c  c   c  (c &  c   c / c  c
  c  c   c  c    c c (c 3  c  c  c  c  c
  c   c  c   ; c  c  c  c  c   c    c
c   c   c / c    c   ; c   c  c  c  c
  c (c c    c   c  c  c   c / c    c
;  c  cc (c&  c! cc  c c   c  c   c c

c
c
  c  c c  c c  c  cc c ! c   c/  c! c
  (c & c c  c c   c   c   c /  c   c
   c  c ;c  c   c   (c  c  ;c  c / c
  c c   c   c ;c  c   c   c  cc
 c  c  ;c    c   c  c  ;c   c  c   c  ;c  c
  c c  c  c  c c c c  (c

c 3  c  c    c   c   c c 1c / (c    c   c cc


!   c   c  c  c / c  c   c   c  c   c c   c
 c / c   c   c   (c   c  c ; c   c c  c c
 (c *  c  c   c  c  c  c   c  c    c  c
  c  c c (c&c  cc  c c  c c  c c  c
  c   c/ (c6;c c cc  c    c c   c
 c   c   c ;(c 4  c  c ;c  c   c   c c   c
  c  c  c    c/  c  c c    c  c   c;c
 c c;c c' c  +(c

c 2/c ;c  c  c   c  c  c c  c ;cc  c


;c (c c   c  c   c //c c  c  c ; c ;c c
 c    c   c  c  c  c !  c '   +c  c   c
(;c  (c à(;c  c c  c   c  c   c   c
(;c cc  c  c  c (c

c
c
c

   c c

,c    c   c   c    c   c (  c ; (c


,cc   cc  c c/  c  0cc c  (c2  c c  c
 c/  c  (c4 c c/  c cc c  c   c
 c  c c  c c cc  c  c(c

c ,c    c  c    c /   c  c (  c  c


  c (   c ; c   c /  c (  c  (c ,  c
  c / c    c ; c  c   c    c   c    c  c
   c  c c   c  c  c  c    c   c c   c
/   c  c c (  (c,  c cc   c   c  c
; c  c  c   cc c  c  (c   c c
   c    c   c  c  c c  c c   c c
  c  c   c   c  c  c   c  c  c   c   c
! c  c (c

c
c
   c! c

c @ c    c   c   c  c  c    c  c  c


  c c  c   c c   c ! c  c ; c  c   c   c
! c  c c ! c   (c @ c c  c   c  c   c   c  c
  c  cc   (c3  c/ c  c  c  c   c
! c c   c  c   c    c /c   c   c ;(c @ c
   c; c   c  cc  c! c  c c cc  c
! c   c  c  c  c  ! (c    c ! c    c   c
   c  c  (c

  c ;c

c    c  ;c  c   c  c   c  c   c  c   c


 c   c c  c  ;c   c    c  c c /  c  ;c  c  c
  c c   c  ;c   (c 6;c  c  c   c c   c  c   c
   c  ;   c   (c    c  ;c  c / c c  c  c
  c  cc c! c   c  c c   cc c
 ;c  c ; c  c  (c C c   c  c   c   c / c
 c  c   c  c   c   c ;c(c

  ; c

c   ; c / c c  c  c   c  c     (c   c


  c   c  c  c  c ; c  c  c  c     c  c
 c  c   c   c   c  c  c  c  c   (c  c
  c  c c   c  c  c   c  c  c   c  c   c  c
  c c c c c   (c  ; c    c'!c+c
  c  c  / c  c  c  c   (c   c   ;c c   c c   c
cc c c c   cc c/  c   c  c  c
c   c   c (c Cc   c  c / c   ;c  c  c   c   c  c
  c   c c  c   c / c  c  c   c   c
  c; c! c   c c  c; c (c

c
c
c à   c    c     c   c   Dc  c c    c
  c c c  c c    c  c c  (c

&; cc

c   c   c  c/ c  (c   c;c c  c cc


  c / c   5  c /  c c  c   c   c  (c * c c
 c  c c   c / c    c c / c  c    c  c
; (c / c    c   c  c  c  c  c    c
  c  c/ c c (c

c  c   c   c ; c   c  c   c  c   c   c


  c  c  (c &; c  c  c ;=c  /c / c   c c
 c c  c;c  c (c

c   c  c; c  c  c  ; cc  c cc/ c


 c  ; c;c  c  c  c c  c c  (cccccccc

C. Definisi Hemoroid

  c   c  c c; c   c  c! cc  c  c


 c  c c c   (c

  c   c   c  c c  c (c   c c   c


 c !(   c   c c  c  c    c  c   c c   (c
  c c c    c    c !  c c   c   c     c   c
/ c c  (cc  c  c  c c c c  c  5
 c   5  c  c c   (c   c  c c /c   c c   c
 c c c (ccc

  c c    c   c  c    c  c   c


; c   c c  c  c  c    c c   c   c c   c c
 (c

3 c  c   c  c  c  c  c    c /  c


  c  c    c  c  c  c ! c  c   c   c  c / c

c
c
 c   c  c  (c  c   c c   c   c c
!(   c   c  c    c c ! c   (c  c   c  cc
  c   c c   c  c  c   c  c  c  c   c c
!(  (c

D. Pathogenesis

c   c   c   c   c    c  c ; c ! c


   c c  c c;  5;  c 7/ (c

c   c  c   c   c c ;  c  c   c  c c  c  c


 c   c  c c  c  c   c 'c   c   c   c   c   c
 c   c c   c   c  c   / c   +c   c   c  c
 c  c c' c  c c  +c  c'   cc  c
 c  c  c c   c   +c  c c  c c c c
 c  c  c  c  c    c c   c   c  c c   c
 c   c c'  c c +c  c    7  (cc

E. Klasifikasi dan deraÿat

c   c   c  ;  c  c   c  c  c  (c   c


 c c   c   cc  0c

#(c &  c#c


* c c   c  c c c  cc c  c  (c  c
  c c c    (c
(c &  cc
   c   c  c   c  c  c  c  c c c
  c  c/  c  (c
1(c &  c1c
   c   c  c   c   c  c  c c   c  c  c
  c   c (c
8(c &  c8cc

c
c
  c   c  c  (c  c  c / c  c   c
  c c; (c

c c

/  c   c   c   c  c  c   c  c 'c  7c   c


 c   +c  c   c  c 'c   7c c  c  c   +(c  c  c
 c    c   c   c c c   c   c    c   c
 c   c  c c  c  c    c c  c   (c /  c
  c  c c  c  c c  c8c  (c

F. Geÿala dan tanda

c  cc  c  c  c  c c  c  c    c


 c  c/ c c  c c  (cc

#(c c c
c  c  c   c  c  c     c  c   c c  c
  c  c  c  cc c   c  (c
(c    cc
   c  c    c  c c  cc  c c
c ;c  c  (c &  c  c  c   c  c  c  c  c
/  c ;c   c   c   c  c   c ;c   c   c   c
 c   c ;c  c  c  c   c   c    c  c  c
c  c   c c c  c  (c

c
c
G. Pemeriksaan

,  c   c   c   c   c c   c   c  c


  cc cc   c / c c  c c   c c  c
 (c   c   c /  c   c   c c  c   c    c
  c ! c c    c  c /  c c  c    c  c (c 2  c   c
  c  c  c  c  c/ (c

  c  c   c   c  c  c   c c  c  c


  c (c,  c   c c  c  c  c  c  (c
  cc c  c  c! /  c c   cc  c (c c
 c   c  c  c c   c   c  c   c  c
   c  c  c  cc  (c

     c  c   c  c   c   c   c   c


  c c  c   c  c  c    c c  c  cc c
  c   c    c   c ;  c   c  c   c  c  (c
c  c c  c   c  c (c

H. Diagnosis Banding

   c / c  c    c ; c  c   c c   c


 c   c   c    c  c !c  c / c   c  c
 c  c  c  c  c c   c c    (c   c
   c  c   (c  c  c  c c    c cc/  c
;c  c  c  c c  c (c

  c / c   c   c   c  c   c   c  c   c


(c

3  c  c c c   c  c   c c c  c
 c   c  c   c   (c 4  c  c  c  c   c   c  c
 c  c  cc  c  c  c (c,  c  c c
c   c  c  c   c  c  c  c  c   c    c ;  c
 (c

c
c
I. Tata laksana

 c   c c  c   c   c   c /  c    (c
  c   c   c    c   c  c   c  c   c c
  c c  c   c  (c

3   c c  c  c c c c  c  c c


  c  / c  c   c  c   c  c  (c à   c   c
c  c   c  c (c à   c c   c    c c  c  c
 c  c c    c; c c   c   c  c
/  c (c

    c  c  c  c   c  c    c ;c  c   c


/ c;c c c (c

  c c  c   c   c c   c  c  c   c


   c  c/  c  c  c c  c c c c / c
 c   c    (c  c   c  c /  c   c   c   c
  c (c ,  c  c  c   c  c  c  c    c
  c  c 2 c  c /c   c  c   c   c  c
  (c

  cc

c   c   c   c    c   c  c   c   c 9Bc
; c   c  c   (c   c  c c     c c   c   c
  c  c   c c   c   c c  c   c    c
   cc c  c  c; /c c   c  (c  c
   c c  c  c  c  c    c  c   c  c   c   c
  (c,  c  c   c  c  c c c  c c  c(c
 c  c  c;c  c  c c  cc  c  c c
 c; c  c  c c  (c

c  c   c   c  c  c  c   c  c   c
   c c c;;c  c  cc  c6c c66(c

c
c
c

4 c c c c

  c  c  c  c  c   c   c   c   c  c


 c  c  c  c   c *  (c & c   c   c   c c  c
  c c   cc c c  c c  c  c  c  (c
E c  c c   c  c  c  c    c /  c   c c c   c
 c    c  (c  c   c   c  c   c   c  (c
à   c c c  c c(c c c  c  c c  c  c
  c  (c   c   c  c  c   c  c   c  c   c
  c c  c   c  c  c  c c  c  c  (ccc

c
c
c

c  c  c c   c   cc  c  c c    (c
 c  c c  c  c  c    c /  c  c  c  c
   (c c  c  c   c   c   c c ;(c    c   c
 c   c   c   c   c  c    c  c   c   c
  c (c

* c c

c   c   c   c   c  c  c   c   c  c  c


 (c * c  c  c  c  c c  c   c /  c  c c   c   c
 c  c   c  c  (c * c  c cc / / c  c  c   ;c
  c  c/ c c  (c

c
c
   cc

c  c  c c  c  c  c   c   c   c  c


  c  c   c   c 666c  c 6@(c  c  c   c   c    c   c
 c  c    c   c  c   c  c  c   c  c /  c
 c   c  c c   (c  c   c   c 6@c  c   c
  c c  c c  c  c c c   (c

c c c  c  c  c   c   cc c  c


   c   c   c  c  5 c  (c )c  c c
   c   c   c  c  c  c   c  c  c   c ;c
 (c

 c c c

c &  c  c  c    c   c c    c  c    c


  c c c  c   c  c  cc c  c  c  c c

c
c
   c;  cc  c   c  (cà c  c   c4 c
c  c c c  c c c   (c

c & c  c  c  c  c   c   c   c  c  c
  (c   c  ! ;c   c     c c    c   c
 c   (c    c   c  c   c  c  c  (c   c
 c  c   c   c  c  c  c  c  c   c
 c  c  c / c   c  c  c  (c

c
c
BAB IV

ANALISIS KASUS

 c 5 c1c  c  c c  c  c c  cc  c
 c1c cà(c cc    c  c  c  c c*,*c c c  cc
 c   c   c  c   c /  c   c  c *,*c  c  c   c
   c   c  c    c   c   c  c  c    (c *  c
 c   c cc  c  c   c cc c c c  c c
 c   c   c  c  c   c  (c , c   c  c   c
  c  c c   c   c   c  c *,*c  c  c  c  c  c  c
   c   c  c (c cc    c c c  c   c c
*,* (cc

 c    c   c *,*c   (c 3 c   c / c   c   c  c


    (c ,  c  c    c / c   c  c  c   (c , c    c
   c   c   c  c  c   c  c  c '  ? +c  c  c
 c '  +c  c    c   c   c  c  (c c * c  c  c
  c    c  c   c  c   c    c    c / c   c   (cc
*  c c  c  c c  c  c  c  c   c  c   c   c
 c   c  c   c   c ;  c c  c ;c '  +(c &   c  c
  c   c   c  c  c /  c  c;c  c  (c * c  c  c
  c  c   c  c ;  c  (c  c    c  c *,*c   c  c
   c  c(c cc  c  cc  c;  c c c c*,*c  c
  c(c& ; c  c c  c;c  cc c   c;  c
  c (c  c    c   c  c   c  c  c   c     c  c
   c ! c;(c c c c    c   cc  (c

  c;c   c  c  c   c  ! c  c c&c##"7<"c


(c   c   c   c  c   c   c   c   (c   c  c
 c    c 6c 0c   c  c  c 1c   c   c  c   c   cc
   cc  c  c  c   cc =cc =c c / (c   c 0cc c '5+c  c
 c  c  (cc

  c  c    c /  ! c  c   c  c  c  c   c


  c ##"7<"c c    c  c    c   c   c  c  c

c
c
 ; c   c (c  c c c   c %c 74c /   c  ; c  c
  c  c c c c   c  c   (c

  c    c   c  c  c  c  c   c ;  c   c


/  c   c 4 = (c , c  c  c  c  c   c ; c
   c  c   (c  c   c  c   c  c @(3c  c   c  c
   (c c   c    c    c   c  c    c   c  c
 c    (c&  c cc   c   (c

c
c
BAB V

PENUTUP

DAFTAR PUSTAKA

#(c   à(   (c &  0c    c ,.c (c ˜         (c
c #(c )c 9(c    0c   c  c &  c 6 c  c &  c 36Dc
""A(c c9%<5A"(c
(c c.&c    c(c˜    ˜(c   0c)E2Dc""9(c c:<5<9(c
1(c ! c ,(/(c E  c  c E   (c   ;  c 3 c 3c  5 c
 (c   c0cc*  c3  c)E2cDc""9(c
8(c   cc   c,c, ?c (c   cc  (c&  c0c3  c c3  (c
à c,/   c36(c#A%(cc1:58(c
9(cc

c
c