LAPORAN KASUS

CYSTITIS

Disusun Oleh
dr. Indah Larasati

PEMBIMBING
dr. Kurnia Utami
dr. Andrian Wulur
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BAB I IDENTITAS PASIEN
Nama : NY. M
Umur : 57 tahun
Agama : Islam
Alamat : Kampung lawang taji RT 01/ RW 10
Suku bangsa : Jawa
Tanggal masuk : 05-12-2019
No RM : 145554
Keluhan utama
Demam
Riwayat Penyakit Sekarang :
 Demam sejak 1 hari SMRS
 pusing (+) disertai mual (+) muntah (-)
 ± 1 hari sebelumnya pasien mengeluh nyeri perut bagian kanan
dan kiri bawah, nyeri terasa terus menerus.
 nyeri saat BAK (+), terasa perih dan panas (+),
 Terdapat bercak darah berwarna merah segar saat BAK (+)
keputihan (-) Hematuria (+). Pasien belum pernah mengalami
sakit yang sama. BAB tidak ada keluhan.
 Riwayat penyakit keluarga :

Riwayat penyakit dahulu : Keluarga tidak ada yang mengalami

keluhan serupa.
Riwayat penyakit seperti ini: -

Riwayat hipertensi : - Riwayat pribadi :

Riwayat diabetes melitus :- Kebiasaan minum air putih : 4-5

gelas sehari
Riwayat penyakit jantung : -
Kebiasaan ganti celana : 3 – 4x
Riwayat operasi sekitar perut :- sehari

Riwayat alergi :- Kebiasaan menahan kencing : diakui

PEMERIKSAAN FISIK
Keadaan umum : tampak sakit ringan, composmentis
Tanda Vital
Tekanan Darah : 130/80 mmhg
Nadi : 83 x/ menit
Pernapasan : 20 x/ menit
Suhu : 37, 2 c
STATUS GENERALIS

Kulit : dbn Abdomen

Kepala : dbn Inspeksi : perut terlihat membesar, ikterik (-),
Mata : CA (-) SI (+) sikatrik (-), caput medusa (-)
Telinga : dbn Auskultasi : bising usus (+) normal
Hidung : dbn Perkusi : tympani (+), nyeri ketok CVA (-/-)
Mulut : dbn Palpasi : nyeri tekan pada lumbal dextra et
Tenggorokan : dbn sinistra (+), distensi (-), defans muskular
Leher : dbn (-), hepar tidak teraba
Thorax : dbn Ekstremitas : dbn
PEMERIKSAAN PENUNJANG
Pemeriksaan Laboratorium

Pemeriksaan Hasil Nilai Rujukan Satuan Pemeriksaan Hasil Nilai Rujukan Satuan
Urin Rutin
Darah rutin
Warna Kuning - -
Hemoglobin 11.5 12.5-15.5 g/dl
Kekeruhan keruh - -
Lekosit 20.7 4 – 10 Ribu Protein Urine Negatif Negatif g/dl

Hematokrit 38.1 35-47 % Glucose urin Negatif Negatif mmol/L

PH 6.5 5-9 -
Trombosit 279 150 - 400 Ribu
Bilirubine urine 0 Negatif Umol/l
Kimia Klinik
Urobilinogen 0 Negatif Umol/L
SGPT 14 0-35 Mg/dl
Berat Jenis urine 1020 1000 – 1030 -
SGOT 10 0-35 Mg/dl
Keton Urine Negatif Negatif Mmol/L
GDS 107 70-140 Mg/dl
Lekosit Positif (+++) Negatif Sel/mL
Ureum 29 10-50 Mg/dl
Erirosit Positif (+++) Negatif Sel/mL

Kreatinin 0.98 0.45-0.75 Mg/dl Nitrit Negatif Negatif -

 Kesan :
USG UROLOGI
Gambaran Cystitis
Tak tampak kelainan pada ginjal
kanan, kiri dan uterus
FOLLOW UP

HARI KE 1

Tanggal S O A P
06-12-2019 Demam(-) nyeri KU : tampak sakit ISK ec cystitis Inf RL 20 Tpm
perut bagian bawah ringan, CM Inj. Levofloxacin 1
berkurang, mual (+) Kepala : CA -/- , x750gr
muntah (-), BAK SI -/- Inj. Omeprazole 1x
nyeri (+) terasa Thorax : 40mg
perih (+), (+) SDV +/+ Spasminal 3x1
berkurang. BJ I-II reguler
Abdomen : perut
datar, BU (+) N. NT
(+) syipisis pubis
Ekstremitas : akral
hangat (+) edema (-
)
FOLLOW UP

HARI KE 2

Tanggal S O A P
07-12-2019 Demam(-) nyeri KU : tampak sakit ISK ec cystitis Inf RL 20 Tpm
perut bagian ringan, CM Inj. Levofloxacin 1
bawah berkurang, Kepala : CA -/- , x750gr (hr ke 2)
mual (+) berkurang SI -/- Inj. Omeprazole 1x
muntah (-), BAK Thorax : 40mg
nyeri (+) SDV +/+ Spasminal 3x1
berkurang terasa BJ I-II reguler
perih berkurang. Abdomen : perut
datar, BU (+) N. NT
(+) syipisis pubis
Ekstremitas : akral
hangat (+) edema (-)
FOLLOW UP

HARI KE 2

Tanggal S O A P
08-12-2019 Demam(-) nyeri perut KU : tampak sakit ISK ec cystitis Inf RL 20 Tpm
bagian bawah ringan, CM Inj. Levofloxacin 1
berkurang, mual (-) Kepala : CA -/- , x750gr (hr ke 3)
muntah (-), BAK nyeri SI -/- Inj. Omeprazole 1x
(-) Thorax : 40mg
SDV +/+ Spasminal 3x1
BJ I-II reguler
Abdomen : perut
datar, BU (+) N. NT (-)
syipisis pubis
Ekstremitas : akral
hangat (+) edema (-)
 BAB II

TINJAUAN PUSTAKA
ANATOMI

Struktur Saluran Vesika Urinaria dan Uretra pada

Kemih Manusia perempuan & laki – laki
DEFINISI

 Bakteriuria bermakna (significant backteriuri) adalah keberadaan

mikroorganisme murni (tidak terkontaminasi flora normal dari
uretra) lebih dari 105 colony forming units per mL (cfu/ml) biakan
urin dan tanpa lekosituria2,3
 Bakteriuria simtomatik adalah bakteriuria bermakna dengan
manifestasi klinik2,3
 Bakteriuria asimtomatik (covert bacteriuria) adalah bakteriuria
bermakna tanpa manifestasi klinik2,3.
EPIDEMIOLOGI
Etiologi
1. Klasifikasi

 Infeksi Saluran Kemih Atas

pielonefritis dan pielitis

 Infeksi Saluran Kemih Bawah

sistitis, prostatitis dan epidimitis, uretritis, serta sindrom uretra.
Sistitis akut adalah radang selaput mukosa kandung kemih
(vesika urinaria) yang timbulnya mendadak, biasanya ringan
dan sembuh spontan (self-limited disease)
Sistitis kronik adalah radang kandung kemih yang menyerang
berulang-ulang (recurrent attact of cystitis) dan dapat
menyebabkan kelainan-kelainan atau penyulit dari saluran
kemih bagian atas dan ginjal
Manifestasi Klinis

pada sistitis akut dapat berupa keluhan-keluhan

Lokal Sistemik
klasik seperti polakisuria, nokturia, disuria,
 Disuria  Panas badan sampai
nyeri suprapubik, stranguria dan tidak jarang
 Polakisuria menggigil
dengan hematuria. Keluhan sistemik seperti
 Stranguria  Septicemia dan syok
panas menggigil jarang ditemukan, kecuali bila
 Tenesmus
disertai penyulit PNA
 Nokturia
 Enuresis nocturnal Perubahan urinalisis
 Prostatismus  Hematuria
pada sistitis akut dapat berupa
 Inkontinesia  Piuria
keluhan-keluhan klasik seperti
 Nyeri uretra  Chylusuria
polakisuria, nokturia, disuria, nyeri
 Nyeri kandung kemih  Pneumaturia
suprapubik, stranguria dan tidak
 Nyeri kolik
jarang dengan hematuria. Keluhan
 Nyeri ginjal
sistemik seperti panas menggigil
jarang ditemukan, kecuali bila disertai
penyulit PNA
 Pemeriksaan Penunjang Diagnosis
Analisis urin rutin

pH urin, proteinuria (albuminuria), dan pemeriksaan

mikroskopik urin
pH >8 (alkalis) selalu menunjukkan adanya
Albuminuria

bakteriuria >105 CFU per ml. Lekosituria (piuria) 10/LPB

a. Uji Biokimia5

a. Mikrobiologi5

a. Renal Imaging Procedures2

 Terapi
a. Infeksi saluran kemih atas (ISKA) 2

Terapi konservatif:
1. SIMTOMATIK
2. ANTIBIOTIK : ampisilin/sulbactam dengan dosis 3
gram / 6 jam, IV, cefalosporin generasi ketiga atau
metronidazole
04

Infeksi saluran kemih bawah (ISKB)

Prinsip manajemen ISKB adalah dengan meningkatkan intake cairan, pemberian antibiotik yang adekuat, dan kalau
perlu terapi simtomatik untuk alkanisasi urin dengan natrium bikarbonat 16-20 gram per hari2,5
Pada sistitis akut, antibiotika pilihan pertama antara lain nitrofurantoin, ampisilin, penisilin G, asam nalidiksik dan
tetrasiklin. Golongan sulfonamid cukup efektif tetapi tidak ekspansif. Pada sistitis kronik dapat diberikan nitrofurantoin
dan sulfonamid sebagai pengobatan permulaan sebelum diketahui hasil bakteriogram
 Komplikasi

a. ISK sederhana (uncomplicated)

Kondisi Risiko Potensial

a. ISK tipe berkomplikasi (complicated)
BAS tidak diobati  Pielonefritis
emphysematous cystitis,  Bayi prematur
 Anemia
Pielonefritis emfisematosa
 Pregnancy-induced
hypertension

ISK trimester III  Bayi mengalami retardasi

mental
 Pertumbuhan bayi lambat
 Cerebral palsy
 Fetal death
Prognosis sistitis akut pada umumnya baik dan dapat sembuh
sempurna
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