Morning Report

Wednesday, February 18th 2015

Trauma Consultant : dr. SD, SpB
Orthopaedic Consultant : dr. SBW, SpOT
Urology Consultant : dr. BS, SpU
Neurosurgery Consultant

: dr. GL, SpBS

Chief : DIN
2nd grade : TDN-AUC/DGT-YWS-AUC-JIC
1st grade

: TGH-PDA-RBN/AWR-TAA/ZAI-SOP-/LUCDIT/GUS-DGN-KWN

Urology
Orthopaedic

: AST
: WRB/ARM/DEN/IPD/YOY-MHR/MAR

RESUME FRIDAY,
Total
th patient
FEB/18 /15

: 38

Trauma

patients

: 28

patients

Non Trauma

: 10

patients

In patient

: 6

patients

Surgery

: 6

patients

Local Anesthetic surgery

: 10

patients

Consultation

: 2

patients

Mortalitaty

: 3

ER
N
o
1

Identitas

Gst Made
Raka/M/55 yo

Gst Ayu Dwi

Eka/F/35 yo

Diagnosis

Terapi

Total ileus obstruksi ec tumor

ekstra lumen + pneumothorak
D

P/Laparatomy
Thoracostomy WSD D

ICD X
K56 intestinal obstruction
without hernia

ICD IX
54.12Laparotomyexploration

CKR(E3V4M6)
V.Appertum R. Frontal
Fr. Basis cranii

Head Up 300

ICD X
S06.1 Traumatic cerebral
oedem
S02.1 fracture base of the skull

O2 face mask 6-8 lpm

IVFD NaCl 0,9% 20 tpm
Paracetamol 3x1 g
Ceftriaxon 2x1 g
Ranitidine 2x50 mg
WT-HT
Konservatif

ER
N
o
3

Identitas

Ayu Putri/F/15 yo

Desy
Purnamasari/F/18
yo

Diagnosis

Terapi

Appendisitis akut
(ALVARADO SCORE: 9)

IVFD RL 20 tpm
Cefazolin 2 g IV pre op
P/ Appendisectomy

ICD X
K35. Acute Appendicitis

ICD IX
47.09 Appendisectomy

Fibrillary astrocytoma
Paraplegi
Ulcus decubitus

Paracetamol 3x1 g IV
Consult plastic surgery

ICD X
C71.9 fibrilary astrocytoma

ER
N
o
5

Identitas

Diagnosis

Ni Nym
Mudriani/F/37 yo

Moderate Head Injury (CKS)

memburuk (E1V1M3)
EDH temporobasal D
ICH temporobasal + parietal D
Fr linier temporal D
ICD X
S06.1 Traumatic cerebral
oedem
S02.0 fracture vault of the skull
S06.4 Epidural haemorrhage
S06.3focalbraininjury

Ni Wyn Parti/F/44 SOL cerebri

Hydrocephalus
yo
G91 Hydrocephalus

Terapi
IVFD NS 20 tpm
Head up 300
O2 8lpm
Ceftriaxon 2x1 g IV
Parasetamol 3x1 g IV
Citicholin 3x500 mg IV
Phenytoin 3x100 mg IV
Trephin clot evacuation + Craneictomy
decompresion

Dexametason 2x 5 mg IV
Paracetamol 3x1 g IV
Betahistin 3x1
Ranitidine 2x50 mg IV

Consultation
No

Identitas

Ferdy
Panggur/M/22
y.o

Sri
Handayani/F/
54 yo

Diagnosis

Terapi

Diagnosis :
CKD stg V ec. Susp PNC + hipertensi g II

Terapi :
Double Lumen Insertion

ICD X
N18.3 CKD stg 5

ICD IX
38.95 Venous
Catheterization for
Renal Dialysis (Double
Lumen Catheter)

ACKD stg V ec susp pre renal on CKD ec susp Terapi :

DKD
Double Lumen Insertion
DM tipe II
Susp gastritis erosive
ICD IX
38.95 Venous
Catheterization for
ICD X
Renal Dialysis (Double
N18.3 CKD stg 5
Lumen Catheter)

Mortality
No

Identitas

By Md
Suardani/M/ 29
days.

Diagnosis
Diagnosis : Neurolastoma post laparotomy biopsy
H0
MRS : 16/01/15
TOD : 18/0215. Pkl 16.20
A:
B:
C: Neuroblastoma

2.

I Gst Md
Sudarsana/M/
38 y.o

Ni Kt
Siwi/F/55 yo

Terapi
Post laparotomy H0
ICD IX
54.9 Laparotomy

IVH + ICH (SH) post trepanasi evakuasi clot +

craniectomy de Capros
MRS : 18/02/15
TOD : 18/02/15 Pkl 19.35

Post post trepanasi evakuasi

clot +craniectomy de Capros

A : Hernia cerebri transtentorial

B : hydrocephalus non communicans
C : SH (ICH + IVH)

ICD IX
01.24 Trephination of cranium

T temporoparietal D tumor primer cerebri R.

temporoparietal D post reseksi tumor H 3
MRS : 16/2/15
TOD : 19/02/15 Pkl 07.05

Post reseksi tumor H3

ICD IX
20.9 resection of tumor

A : herniasi cerebri
B : tumor cerebri
C : tumor primer serebri

SURGERY REPORT

I Gst Made Raka / L / 52 thn

Diagnose : Ileus obstruksi ec adhesion
Surgery : Total ileus obstructive ec. Extra
lumen tumor
Operator
: dr. Aussie
Asisten : dr. Rimbun
Pembimbing : dr. Made Agus Suetha, Sp B-KBD

Ni Wayan Sukatini / F / 72 yo
Diagnosis : Right incarcerated lateral inguinal
hernia
Tindakan : Herniotomy + mesh
Operator
: dr. Yulius Wimbo
Asisten : dr. Agung Danan
Pembimbing : dr. Sudiasa, Sp.B

I Wayan Agus Yudiarta / M / 19 yo

Diagnosis : Acute appendicitis

Tindakan : Appendisectomy
Operator
: dr. Tri Andi
Asisten : dr. Esa
Pembimbing : dr. Sudiasa, Sp.B

Ayu Putri/ F / 15 yo

Diagnosis : Acute appendicitis

Tindakan : Appendisectomy
Operator
: dr. Yudit
Asisten : dr. Aussie
Pembimbing : dr. Sudiasa, Sp.B

I Md Swana / M / 74 yo

Diagnosis : Retensio urine

Tindakan : Open cystostomy
Operator
: dr. Anugerah
Asisten : dr. Astri
Pembimbing : dr.Budi Santoso, Sp.U

RADIOLOGY REPORT
Total radiology : 10 pc
CT scan : 3 pc
Rontgen : 7 pc
( 2 pc havent been taken )

CASE 1

Ni Wyn Sukatini/ F / 72 y.o

T.Arr 05.14

Patient complained with pain on her right lower stomach

since 1 day prior admission. She also felt of lump comes out
from the right inguinal when coughing. Nausea (+) vomiting
(+), fever (-).

History of lump at inguinal comes and go (+)

Patient was refered from Tabanan Hospital with Dx HIL (D)

Incarcerated

Status General
BP : 120/80mmHg, P : 88 x/min, RR : 20x/min, T.ax : 37,0oC, VAS : 5
Eye
: anemic -/- icteric -/Thorax : cor : S1 S2 single reg murmur(-)
Po : Ves +/+, rh -/-, wh -/-

Abdomen
Ins
: distension (-), mass (+) 10 cm at right inguinal, fixated
Aus
: Bowel sound (+) increased
Palp
: tenderness (-), defans (-)
Per
: tymphani
Extr
: warm
DRE
: inspection : normal, normal anal sphincter tone,
smooth
mucosa surface, mass (-), glove: stool (+),
blood (-)
Ass :
Incarcerated HIL (D)
Px penunjang :
DL : WBC 14,9 / Hb 16,2 / Neu 62,4 / lim 27,4/ HCT 47,4 / PLT 301
BS 146 / BUN 34 / SC 0,8 / PPT11,2 / APTT 27,3 / INR 0,97 /
SGOT 14 / SGPT 29 / CT 7.30 / BT 1.00

Dx :
Right Incarcerated Lateral Ingunal Hernia
ICD X
K40.30 Inguinal lateral hernia with obstruction
Tx :
IVFD RL 20 tpm
NGT decompression
DK insertion
Trendelenburg position
Diazepam 10 mg supp
Cefazolin 2 gr iv pre op
Herniotomy + ileum resection + anastomose end to end + mesh
ICD IX
53.0 Unilateral repair of hernia (Herniotomy)

CASE

INGUINAL HERNIA

Definition
A hernia is an abnormal weakness or hole in an
anatomical structure which allows something inside
to protrude through.
It is commonly used to describe a weakness in the
abdominal wall.
Hernias by themselves usually are harmless, but
nearly all have a potential risk of having their blood
supply cut off (becoming strangulated).
If the blood supply is cut off at the hernia opening in
the abdominal wall, it becomes a medical and surgical
emergency.

AETIOLOGY

COMPOSITIONOFAHERNIA
The Sac
Consisting : mouth, neck, body and fundus
Diameter of neck narrow strangulation

The covering
Layer of abdominal wall

Contents

Omentum (omentocele / epiplocele)

Intestine (enterocele)
Richters hernia
Littres hernia

CLASSIFICATION

CLASSIFICATION

ANATOMYOFINGUINALCANAL

Direct inguinal hernia

Indirect inguinal hernia

COURSE OF INDIRECT INGUINAL HERNIA

Loop of bowel entering hernia
sac

Neck of hernial sac

Inferior epigastric vessels
Origin of infundibuliform (internal
spermatic) fascia

Superficial inguinal ring

Hernial sac
Vas deferens and vessels of spermatic cord

Vas deferens, testicular vessels and genital branch of

genitofemoral nerve entering spermatic cord

Peritoneum
Extraperitoneal areolar tissue
Transversalis fascia

External spermatic (intercolumnar) fascia

Cremasteric fascia
Infundibuliform (Internal Spermatic) Fascia

Strangulated inguinal hernia

Inguinal hernia incarcerated

due to old thickened sac and
adhesions
Inflamed appendix in hernial sac

Clinical Features

Expansile cough
Transillumination test
Finger Test
Thumb Test
Ziemen Test (Three
finger Test)

DIFFERNTIAL DIAGNOSIS IN THE MALE

Encysted hydrocele of the cord
Femoral hernia
Incompletely descended testis in
the inguinal canal
Lipoma of the cord

DIFFERNTIAL DIAGNOSIS IN THE FEMALE

Hydrocele of the canal of Nuck
Femoral hernia

Treatment
Operation is the treatment of choice

Surgery
Herniotomy
Herniorrhaphy
Bassinis Repair
Shouldice Repair

Hernioplasty
Lichtenstein

Laparoscopic Repair :
TAPP (Transabdominal
approach)
TEP (Preperitoneal
approach)

Surgical Technic

BASSINIREPAIR

LICHTENSTEIN TECHNIQUE
(TENSION FREE REPAIR)
The
polypropylene
mesh laid down
onto the posterior
wall of the
inguinal canal
(the transversalis
fascia).
Note the end tails
of the mesh patch
embracing the
cord

THANK YOU

Ferdy Panggur / M / 72 yo
Diagnosis : CKD stg V ec. Susp PNC +
hipertensi g II
Tindakan : Double lumen insertion
Operator
: dr.
Asisten : dr.
Pembimbing : dr. Putu Yasa, Sp.BTKV