Visi dan Misi Program Studi Spesialis Ilmu Bedah

Fakultas Kedokteran Universitas Udayana

Visi
Menjadikan Program Studi Spesialis Ilmu Bedah sebagai pusat pendidikan, pelayanan, dan penelitian yang unggul,
mandiri, dan berbudaya serta menghasilkan lulusan yang memiliki kelebihan khusus dalam bidang traumatologi dan
bedah akut yang dapat bersaing di tingkat regional, nasional, dan internasional pada tahun 2025.

Misi
• Menyelenggarakan Tri Dharma Perguruan Tinggi yang berkualitas, unggul, mandiri, dan berbudaya di bidang
Ilmu Bedah yang mampu bersaing secara global.
• Menyelenggarakan pendidikan Ilmu Bedah yang didukung oleh pengembangan sumber daya manusia dengan
kepribadian, kemampuan, dan keterampilan yang berkualitas serta fasilitas yang memadai.
• Menyelenggarakan pendidikan Ilmu Bedah yang didukung oleh kerjasama tim, etos kerja yang baik, dan
senantiasa membina hubungan baik dengan institusi baik di dalam maupun di luar negeri.
• Menyelenggarakan Pendidikan Ilmu Bedah dengan keunggulan dibidang traumatologi dan bedah akut yang
dijabarkan dalam bentuk alokasi waktu tersendiri sebagai program unggulan lokal .
 MORNING REPORT
Tuesday, May 30th 2023
Trauma Consultant dr. Ketut Sudiasa, Sp.B(K)Trauma
Oncology Consultant Dr. dr. Putu Anda Tusta Adiputra, Sp.B, Subsp. Onk(K)
Plastic Surgeon Consultant Dr. dr. Agus Roy Rusly Hariantana Hamid, Sp.B.P.R.E., Subsp.T. (K)
Urology Consultant Dr. dr. Gede Wirya Kusuma Duarsa, M.Kes, Sp.U(K)
Neurosurgery Consultant Dr. dr. I Wayan Niryana, M.Kes, Sp.BS, Subsp. N-Vas
Orthopaedic Consultant  dr. Cok Gde Oka Dharmayuda,Sp.OT(K)
Vascular Consultant dr. IGAB Krisna Wibawa, Sp.B, Subsp. BVE(K)
Cardiothoracic Vascular and Endovascular Consultant dr. I Wayan Sudarma, Sp.BTKV, Subsp. T(K)
Vascular: dr. I Komang Adhi Parama Harta, Sp.BTKV, Subsp. JD(K)
Digestive Consultant Dr. dr. I Ketut Sudartana, Sp.B, Subsp. BD(K)
Paediatric Surgeon Consultan dr. Kadek Deddy Ariyanta, Sp.B, Sp.BA, Subsp. DA(K)
Chief of the Residents            ENN
Leader     NIT
Senior residents     APK/GDP/DAM/GMA/ALX/ASA/GSK
Junior residents                    TOM/STW/SPD/AMK/SAL/SRY/AWB
Urology residents   KEM
Neurosurgery Residents  DCA//SAM/DJP/RAN/GER/DIC/ASK/MBP
Plastic Surgery Residents   ZEN/GEP/GIT/GUE/ROS
Orthopaedic Surgery Residents  MAC//WIR/GKS-GAK/BOB/WAS/MHA/MAS
 RESUME

Total patients : 17 patients

Trauma : 6 patients
Non trauma : 11 patients
Hospitalized : 5 patients
Consultation : 4 patients
Surgery : 0 patient
Minor Surgery with LA : 5 patients
Mortality : 0 patient
Emergency Unit
 Surgical Emergency Ward Bed 2
No Identity Diagnosis Management
1 I Kadek Ariawan / M / 45 y.o • Septic Shock post One Hour Bundle of Sepsis •
•
Treat Intensive Room
One hour sepsis bundle (already done at the previous hospital)
. / 23008396 / BPJS • Burst Abdomen • - Loading RL 30cc/KgBB/hour ~ 1960cc/hour then 20tpm (already)
• Ductal Adenocarcinoma Pancreas (pT1cpN2M0) • - 2-sided blood culture
post Whipple Procedure (24/2/23) • - Ceftriaxone 1gr every 12 hours (already)
• Post drainage billiard (15/2/23) at Puri Raharja • NPO
• TPN with a calorie requirement of 1800kcal
Hospital • IVFD NaCl 0.9% : D5% : Kabiven = 2:1:1/24 hours IV
• Post chemotherapy series gemcitabine 1 day 8 • O2 FM 10 lpm
(29/5/23) • Omeprazole 40 mg / 12 hours IV
• Leukocytosis (17.80) • Paracetamol 500 mg / 8 hours PO
• Albumin transfusion 1 bag / day albumin target > 3 g/dl
• Hypoalbumin (2.1) • Vascon 0.2mcg/kgbb/hour ~ 9ml/minute, maintain MAP > 65
• Hyponatremia (131) • Treat daily wounds with modern dressings
• KS 40 • Observation of hemodynamics and urine output

ICD 9
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
Z79.891 The use of analgetic
99.21 Injection of antibiotic

ICD 10
R65. 21 Severe sepsis with septic shock
C25.9 Malignant neoplasm: Pancreas
D72. 82 Elevated white blood cell count
E87. 5 Hyperkalemia
E87. 1 Hypo-osmolality and hyponatremia
R77.0 Abnormality of albumin
 Surgical Emergency Ward Bed 3
No Identity Diagnosis Management
2 Siti Saharyahny / F / 69 y.o • Complete Prolapse Recti • Pro Urgent Rectopexy
/ 14002935 / BPJS • CHF FC II due to Suspect CAD + HH • Consult to Anesthesia division
EF BP 39%, RWMA (+) • IVFD NaCl 0.9% 20 dpm
•
• Cefoperazone 1 gram every 12 hours iv
• Antero-lateral ischemia • Ketorolac 30mg IV
• HT stage I • Paracetamol 500 mg for K/P pain
• Mild Anemia (10.8) • Omeprazole 40 mg every 12 hours iv
• Acute Pain (VAS 3/10) • Cover the prolapse with damp gauze with nacl
• AKI dd ACKD
Anasthesia Division
ASA III

Cardiology Division
Switch ACE-i to Initiate Uperio 50mg every 12 hours PO
Anti failure therapy and hypertension
Blood pressure regulation
Therapy
Acetosal 80 mg every 24 hours (post OP initiation)
Simvastatin 20 mg every 24 hours
Bisoprolol 1.25mg every 24 hours
Amlodipine 10 mg every 24 hours
Ramipril 10mg every 24 hours (Delay according to TS Anesthesia)
Furosemide 40mg K/P shortness of breath
Spironolactone 25 mg every 24 hours
Digoxin (Stop)
ICD 10
K62.3 Prolapse of rectal mucosa ICD 9
J18.9 Pneumonia 99.2 Injection or infusion of other therapeutic or prophylactic substance
I50 Heart failure V58.69 The use of other medication
I10 Essential (primary) hypertension Z79.891 The use of analgetic
G89.1 Acute pain 99.21 Injection of antibiotic
 Surgical Emergency Ward Bed 10
No Identity Diagnosis Management
3 I Wayan Sana / M / 58 y.o • Temporary CDL malfunction of the right internal - Pro remove temporary CDL Right Internal jugular
/ 23028888 / BPJS jugular vein vein + Insertion of tunneled CDL Right Internal
• CKD stage V on HD Regular (Tuesday-Friday) at jugular vein
Karangasem Hospital
• Stage II hypertension

ICD 9
58.81 Placement of catheter through a newly established venous access

ICD 10
V56.1 Mechanical complication of vascular dialysis catheter
N18.9 Chronic kidney disease
I13.0. Hypertensive heart
 Surgical Emergency Ward Bed 2
No Identity Diagnosis Management
4 I Nyoman Musko/ M / 63 y.o • Right pneumothorax post insertion of the right chest • WSD Suction Active -15mmHg
/ 23028892 / BPJS tube (05/30/2023) • IVFD NaCl 0.9% 20 dpm
• Fracture Costa Multiple 3-8 Right Posterolateral • Pain Management with Pethidine 100mg + Ketorolac 60mg
Aspect with Complications in D5% 500 cc in 24 hours
• Right subcutis emphysema • Cefoperazone 1gram every 12 hours IV
• Close Clavicle fracture right Middle 1/3 Allman • Observation for production + WSD function
Group 1 • Observation for signs and symptoms of respiratory distress
and the expansion of subcutaneous emphysema
• Treat periodic injuries
• Consult to Orthopedics division for the management of Fr.
Clavicula Dextra

• POC : Pro clipping costae urgent

Orthopaedic Region
ORIF-PS (Clavicle) (elective)

ICD 9
ICD 10 34.04 Insertion of intercostal catheter for drainage.
S22. 49 for Multiple fractures of ribs 99.2 Injection or infusion of other therapeutic or prophylactic substance
J93.9 Pneumothorax V58.69 The use of other medication
J43. 9 Emphysema Z79.891 The use of analgetic
S42. 0 Fracture of clavicle 99.21 Injection of antibiotic
79.02 Clipping costae
 Surgical Emergency Ward Bed 1
No Identity Diagnosis
5 Lukas Ely / M / 29 yo / 23028901 / • Rapid response hypovolemic shock
BPJS • Pelvic Ring Injury (Open book fracture)
• Post stabilization with pelvic binder
• Suspect rectal laceration dd/Rupture
ICD 10
R57.1 Hypovolemic shock
S32.810A Multiple fractures of pelvis
K63 .1 - Perforation of intestine
Management
- Explore Anus with Rectoscopy Join Op Orthopedic
division at Emergency operating room
- IVFD NS 20 dpm
- Ketorolac 30 mg/ 8 hours IV
- Ceftriaxone 1gr/12 jam IV
- Pelvic stabilization according to Orthopedic division
Orthopaedic Division
Pro Debridement + External Fixation anterior frame at
Emergency Operating room
ICD 9
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
Z79.891 The use of analgetic
99.21 Injection of antibiotic
48.2 Diagnostic procedures on rectum, rectosigmoid and perirectal tissue
Consultations
 Medical Emergency Ward Bed 10
No Identity Diagnosis Management
1 Ursula Virginia Ahnan / F / 84 y.o • Bilateral lower extremity CLTI Rutherford grade IV
- Pro CTA + C bilateral inferior extremities (arterial
/ 23027755 / BPJS • DM type 2
• ACKD due to susp pre renal on CKD ec susp DKD phase and venous phase)
dd NS - Wounds care periodically
• CAD
Intenna Division
- IVFD NaCl 0.9% 1500 ml/24 hours
- Diet DM + CKD 1900 kcal/day + Protein 0.8 gr/kgBB/day
- Paracetamol 750 mg every 8 hours
- Insulin Glargine 10 units every 24 hours (SC)
- Glulisine insulin 4 units every 10 minutes before the main
meal (SC)
- Candesartan 16 mg every 24 hours (intraorally)
- Bisoprolol 2.5 mg every 24 hours (intraoral)
- Check for HbA1C

ICD 10
I99.8 chronic limb-threatening ischemia NOS of native arteries of extremities
I25.812 Atherosclerotic heart disease of native coronary artery with angina pectoris with
documented spasm ICD 9
N18.9 Chronic kidney disease 88.01. Computerized Axial Tomography
E11.42 Other specified diabetes mellitus
879.8 Wound Care
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
99.21 Injection of antibiotic
99.07 Transfusion of Nonautologous Serum Albumin
Z79.891 The use of analgetic
 Medical Emergency Ward Bed 6

No Identity Diagnosis Management

2 I Nyoman Nuada / M / 64 y.o
/ 01172936 / BPJS
-
• Perianal abscess Incision + Drainage Abscess at Emergency Operating Theater
• ACKD ec susp prerenal on CKD ec susp DKD Internal medicine division
• Hyperglycemia (370) IVFD Nacl 0.9% 20 tpm
- CKD diet 2000 kcal/day + protein 40gr/day
• DM type 2 - Omeprazole 40 mg every 12 hours IV
• CCAD 3VD (CTO at LAD) - metoclopramide 10 mg every 8 hours IV
- Sansulin 1x18 IU every 24 hours SC
- Apidra 3x8 IU SC 10 minutes before eating SC
- drochlorothiazide 1x12.5mg PO
- atorvastatin 1x20mg PO
- Furosemide 2x40mg PO
- miniaspi 1x80mg PO
- clopidogrel 1x75mg PO
- allopurinol 1x300 mg PO
- nitrocafe 2x100mg PO
ICD 10
K59.9 Perianal abscess
E11. 621 Type 2 diabetes mellitus with foot ulcer
I25.812 Atherosclerotic heart disease of native coronary artery with angina pectoris with
documented spasm
N17.9 Acute kidney failure, unspecified ICD 9
E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease 86.04 Other Incision With Drainage Of Skin And Subcutaneous Tissue
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
99.21 Injection of antibiotic
Z79.891 The use of analgetic
 Isolation Emergency Ward Bed 1

No Identity Diagnosis Management

3 Ni Ketut Sinta Aprianti / F / 10 y.o
/ 23028903/BPJS
• Left flank region tumor with secondary infection • Pro Thoracostomy Chest Tube Insertion - LeftWSD +
due to suspected TB Abscess Drainage Incision in Emergency Operating Room-
• Massive left pleural effusion • Pus culture + examination of PA tissue
• Mild Anemia (9.2) • Educate Patient's Family
• Leukocytosis (18.76) • Pre Op
• Thrombocytosis (667)
Anesthesia Division
ASA III

Pediatric Division
- Patient will be followed up further by TS Pediatric
Respirology Division
- Further investigation of TB suspicion
- Advice X-Ray lateral decubitus, evaluation of pleural
effusion
- if an incision is made, suggestions for abscess culture,
abscess tissue cytology and wound bed and TCM Abscess

ICD 10 ICD 9
D17.1 Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk 34.04 Insertion of intercostal catheter for drainage.
J90 Pleural effusion 87.44, X-Ray Of Routine Chest
D64. 9 Anemia V58.69 The use of other medication
 Medical Emergency Ward Bed 14

No Identity Diagnosis Management

4 I Nengah Ardika / M / 37 y.o
/ 23017954 / BPJS
• Observation for Abdominal Pain ec susp erosive
gastritis
• Hematemesis due to suspected erosova gastritis
• Aplastic Anemia
• Suspected Varicella zoster
• Currently there are no signs of obstructive ileus, no specific
therapy in the field of digestive surgery
• Other therapy according to Interna division
• Proposed EGD examination
• Keep the NGT
• Fleet enemas every 12 hours
• Observation of complaints, VS, Signs of acute abdomen

ICD 10
K29.60 -Other gastritis with bleeding
D61. 9 Aplastic anemia
B02.8 Zoster with other complications
ICD 9
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
Z79.891 The use of analgetic
99.21 Injection of antibiotic
Surgery
Mortality
Thank You
 Surgical Emergency Ward Bed 2
I Kadek Ariawan / M / 45 y.o. / 23008396 / BPJS
Referral patient from Klungkung Hospital to Digestive Surgery Division with Septic Shock + Ductal adenocarcinoma of the
pancreas (pT1cpN2M0) post Whipple procedure 24/2/2023 + Left pleural effusion for further treatment

Chief Complaint :
Shortness of breath

Present Illness
Patients with complaints of shortness of breath, shortness of breath that has been felt since 3 days, shortness of breath
that is getting worse, tightness that does not improve with a change in position, complaints of shortness of breath that
the patient has never felt before, fever (-), cough (+) accompanied by yellow phlegm, nausea (-) , vomiting (-), the patient
also feels weak, the patient also feels minimal pain in the abdominal area and there is a wound in the operating area, the
wound is seeping yellow
The patient was treated for gemcitabine chemotherapy series 1 day 8 (29/5/23)
Past Illness:
- Ductal Adenocarcinoma of the pancreas (pT1cpN2M0) post Whipple procedure(24/2/23)
- Post drainage billier (15/2/23) at Puri Raharja Hospital
- Post chemotherapy gemcitabine series 1 day 8 (29/5/23)

History of Treatment:
- vascon start 0.05 mcq/kg
- Ceftriaxone 2 grams every 24
Present Status Local Status
General condition : moderate Abdominal Region :
GCS : E4V5M6 I : distention (-), scar post operation (+) with size
BP : 90/55 mmHg on vascon 0.2 mc2/kg -/+ 2x2 cm
HR : 99 x/min seepage (+) is yellow
Temp : 36.7 C A : Bowel sound (-) 1-2 x/min
RR : 22 x/min P : Soepl, the mass is not palpable, defans (-),
SpO2 : 99% on NRM 15 lpm evaluation of the wound base of the small
Weight 65 kg Height 180 cm BSA 1.83 intestine
KS 60 P : tymphani

General Status: RT :
Eyes: anemic -/-, jaundice -/- TSA (+), recti ampulla not collapsed, mucosa
Thorax: smooth, no mass palpable, tenderness (-)
- Cor : S1 S2 single regular, murmur (-) HS: feces (+), mucus (-), blood (-)
- Pulmo : Ves +/+ rh -/- wh -/-
Abdomen: ~ local status
Extremity :warm, CRT < 2 second, edema +/+
Clinical Appearance
Laboratory Results 30/05/2023 KlungkungHospital

WBC 17.80/ HGB 11.2/ PLT 184/ SGOT 10/ SGPT 10/ Alb 2.1/
Bun 48/ Sc 0.6/ Na 131/ K 4.3/ Cl 98/ GDS 115pH 7.40/ PCO2
303.3/ PO2 65.0/ HCO3- 19.0/ TCO2 20.0/ Be(B) -6.0/ SO2
93.0/ FiO2 81.00
Chest X-Ray 31/05/2023 Klungkung Hospital
Abdominal USG 14/04/2023 Prof. Ngoerah Hospital
Abdominal USG 14/04/2023 Prof. Ngoerah Hospital
Abdominal USG 14/04/2023 Prof. Ngoerah Hospital
Abdominal USG 14/04/2023 Prof. Ngoerah Hospital

- No visible pancreatic structures (post Op), no visible mass picture in

the epigastric region surgical bed
- Currently there are no metastatic nodules in the liver or lymph node
enlargement
- Hepar, spleen, right and left kidney, bladder and prostate did not
show any abnormalities
 PA 6/2/2023 Prof. Ngoerah Hospital

- Antrum, Duodenum, Jejunum, Pancreas, Common Bile Duct;

- Histomorphology shows
a Moderately differentiated ductal
Pancreatic Adenocarcinoma
- Margin Antrum, jejunum, neck and pancreas
tumor-free uncinate process.
- Appears infiltration of tumor masses in the area of ​the duodenum, ampulla of
Vater and common bile duct
- Visible malignant cell infiltration in 7 out of 10 KGB structures and on structures
spleen accessory.
- pT1c pN2 pMx
DIAGNOSIS MANAGEMENT
• Septic Shock post One Hour Bundle of Sepsis • Treat Intensive Room
• Burst Abdomen • One hour sepsis bundle (already done at the previous hospital)
• Ductal Adenocarcinoma Pancreas (pT1cpN2M0) post Whipple • - Loading RL 30cc/KgBB/hour ~ 1960cc/hour then 20tpm
Procedure (24/2/23) (already)
• Post drainage billiard (15/2/23) at Puri Raharja Hospital • - 2-sided blood culture
• Post chemotherapy series gemcitabine 1 day 8 (29/5/23) • - Ceftriaxone 1gr every 12 hours (already)
• Leukocytosis (17.80) • NPO
• Hypoalbumin (2.1) • TPN with a calorie requirement of 1800kcal
• Hyponatremia (131) • IVFD NaCl 0.9% : D5% : Kabiven = 2:1:1/24 hours IV
• KS 60 • O2 FM 10 lpm
• Omeprazole 40 mg / 12 hours IV
• Paracetamol 500 mg / 8 hours PO
• Albumin transfusion 1 bag / day albumin target > 3
• Vascon 0.2mcg/kgbb/hour ~ 9ml/minute, maintain MAP > 65
• Treat daily wounds with modern dressings
• Observation of hemodynamics and urine output

ICD 10
R65. 21 Severe sepsis with septic shock
C25.9 Malignant neoplasm: Pancreas ICD 9
D72. 82 Elevated white blood cell count 99.2 Injection or infusion of other therapeutic or prophylactic substance
E87. 5 Hyperkalemia V58.69 The use of other medication
E87. 1 Hypo-osmolality and hyponatremia Z79.891 The use of analgetic
R77.0 Abnormality of albumin 99.21 Injection of antibiotic
 Surgical Emergency Ward Bed 9
Siti Saharyahny / F / 69 y.o. / 14002935 / BPJS
Referral patient from Balimed Hospital with Prolaps Recti

Chief Complaint :
Lumps in the anus

Present Illness
Patient with complaints of a lump coming out of the anus that has been felt since 2 years of SMRS. The lump was said to
be small at first but grew bigger. Complaints have gotten worse in the last 6 months and were said to have come out 3
days ago. The lump was put in the BaliMed Hospital but soon came out again. CHAPTER (+) last 2 days ago, flatus (+),
urination (+), bleeding from the anus (-). Abdominal pain (-), flatulence (-), nausea (-), vomiting (-), fever (-)
 History of Treatment:
Past Illness:
-IVFD NS 8 tpm
- The patient has a history of giving birth 8 times
-Oxygen nasal cannula 2 lpm
vaginally.
-Levofloxacin 1x750 mg IV
- History of a lump coming out of the anus 2 years
-farbivent nebulization 3x1
ago was treated with herbal medicine
-methylprednisolone 2x62.5 mg IV
- History of HT (+) since 1 year
-omeprazole 2x40 mg IV
- History of ADHF Profile B since 3 days ago
-Furosemide 3x20 mg IV
- DM history (-)
-Amlodipine 1x10 mg
-Ramipril 1x10 mg
Operation History
-Bisoprolol stop
- History of post-appendectomy appendicitis in 2021
-Digoxin 1x0.25 mg
at Bali Med Denpasar Hospital
-Spironolactone 1x100 mg
Present Status Local Status
General condition : moderate Anus Region :
GCS : E4V5M6 There is a rectal mass measuring 10x6 cm, pink
BP : 140/80 mmHg in color, viable, active bleeding (-), minimal
HR : 90 x/min mucus (+), Tenderness (+)
Temp : 36.4 C
RR : 23 x/min RT :
SpO2 : 98% on Room air TSA (+), recti ampulla not collapsed, mucosa
smooth, no mass palpable, tenderness (-)
General Status: HS: feces (+), mucus (-), blood (-)
Head : normocephaly
Eyes: anemic -/-, jaundice -/-
Thorax:
- Cor : S1 S2 single regular, murmur (-)
- Pulmo : Ves +/+ rh -/- wh -/-
Abdomen : soepl, bowel sound (+) normal,
defans (-), tenderness (-)
Extremity :warm, CRT < 2 second, edema +/+
Clinical Appearance
 Laboratory Results 31/05/2023 Balimed Hospital

WBC 7.8 / HGB 10.2 / PLT 264 / SC 1.03 / BUN 37.5 / e-LFG
56 / Na 143 / K 3.8 / Cl 107 / Kalsium total 8.83 / Kalsium
Ionized 4.37 AGD pH 7.4 / PCO2 38.4 / PO2 67 / TCO2 27 /
HCO3 26.30 / BEecf 1.9 / SO2 94.1
Chest X-Ray 28/05/2023 Balimed Hospital

Impression
Cardiomegaly
Congestive pulmonum with lung edema
dd pneumonia
DIAGNOSIS
• Complete Prolapse Recti
• CHF FC II due to Suspect CAD + HH
• EF BP 39%, RWMA (+)
• Antero-lateral ischemia
• HT stage I
• Mild Anemia (10.8)
• Acute Pain (VAS 3/10)
• AKI dd ACKD
ICD 10
K62.3 Prolapse of rectal mucosa
J18.9 Pneumonia
I50 Heart failure
I10 Essential (primary) hypertension
G89.1 Acute pain
MANAGEMENT
• Pro Urgent Rectopexy
• Consult to Anesthesia division
• IVFD NaCl 0.9% 20 dpm
• Cefoperazone 1 gram every 12 hours iv
• Ketorolac 30mg IV
• Paracetamol 500 mg for K/P pain
• Omeprazole 40 mg every 12 hours iv
• Cover the prolapse with damp gauze with nacl
Anasthesia Division
ASA III
Cardiology Division
Switch ACE-i to Initiate Uperio 50mg every 12 hours PO
Anti failure therapy and hypertension
Blood pressure regulation
Therapy
Acetosal 80 mg every 24 hours (post OP initiation)
Simvastatin 20 mg every 24 hours
Bisoprolol 1.25mg every 24 hours
Amlodipine 10 mg every 24 hours
Ramipril 10mg every 24 hours (Delay according to TS Anesthesia)
Furosemide 40mg K/P shortness of breath
Spironolactone 25 mg every 24 hours
Digoxin (Stop)
ICD 9
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
Z79.891 The use of analgetic
99.21 Injection of antibiotic
 Surgical Emergency Ward Bed 10
I Wayan Sana / M / 58 y.o / 23028888 / BPJS
The patient came to bring an referall from Dr. IGAB Krisna Wibawa, Sp.B, Subsp.BVE(K) for CDL insertion plan D internal jugular vein tunneling

Chief Complaint :
Malfunction of dialysis access

Present Illness
The patient came with complaints of congestion at dialysis access since 5 days before admitted. Previously access could be used, but it was jammed during
dialysis. Dialysis has been done for 1 hour, usually can be done 5 hours. Weakness complaints (-), fever complaints (-), chills during HD (-), shortness of
breath (-), nausea (-), vomiting (-)
Regular HD patient Tuesday - Friday. The last HD was Friday 26/05/2023 for 1 hour at Karangasem Hospital

Past Illness:
- CKD stage V since February 2023
- HT (+) since 10 years (not taking medication)
- DM (-) history of heart disease (-)
Operation History
- Post kidney stone surgery 2020 at Karangasem Hospital
- Post temporary CDL insertion v. Jugular D at Karangasem Hospital (February 2023)
- Post temporary CDL insertion v. Jugular D at Karangasem Hospital (late March 2023)
- Post temporary CDL insertion v. Jugular D at Karangasem Hospital (April 2023)
- Post reinsertion CDL temporary v. Jugular D at Karangasem Hospital (April 2023)
- Post temporary CDL insertion v. Jugular D at Karangasem Hospital (May 2023)

Medication History
Allopurinol 100 mg every 12 hours
Folic acid every 12 hours
Present Status Neck region
CDL temporary appears, Treated, seepage (-), bleeding
General condition : good (-), function (-), hyperemic (-)
BP : 130/80 mmHg
HR : 81 x/min
Temp : 35.8 C
SpO2 : 98%

General Status:
Eye : anemic -/-, jaundice -/-
ENT: normal
Cardiac : S1S2 single regular, murmur (-)
Pulmo : Ves+/+, rh -/-, wh -/-
Abdomen : soepl, bowel sound (+) normal, defans (-),
tenderness (-)
Ext : warm +/+, CRT< 2s, edema +/+

Local Status
Clinical Appearance
Laboratory Results 31/05/2023 Prof Ngoerah Hospital
Chest X-Ray 24/05/2023 Prof Ngoerah Hospital
Impression:
Heart and pulmo do not appear
abnormalities
DIAGNOSIS MANAGEMENT
• Temporary CDL malfunction of the right internal jugular vein - Pro Insertion of CDL Right Internal jugular vein tunneling
• CKD stage V on HD Regular (Tuesday-Friday) at Karangasem
Hospital
• Stage II hypertension

ICD 9
58.81 Placement of catheter through a newly established venous access

ICD 10
V56.1 Mechanical complication of vascular dialysis catheter
N18.9 Chronic kidney disease
I13.0. Hypertensive heart
 Medical Emergency Ward Bed 12
Ursula Virginia Ahnan / F / 84 y.o / 23027755 / BPJS
Chief Complaint :
Pain on the left foot

Present Illness
The patient came with complaints of pain in the left leg since 1 month ago, complaints of pain were said to be sudden, and then since 2 weeks the pain has
felt heavy when moved, and it started to improve when it was rested initially 2 weeks ago the skin on the left leg was said to be blistered , then the feet
start to turn blue-black and smell, complaints of tingling (+) from the soles to the calves. Complaints resulted in the patient being unable to walk
Fever (-), shortness of breath (-), cough (-).
complaints of nausea and vomiting (-), eat and drink little by little.
Defecation and urination said there were no complaints.
The patient's history when walking pain in the legs (+) and improves when resting

Past Illness:
- Patients with a history of DM since > 10 years
- History of hypertension (+) routine with medication
- History of stroke attack 2x
- Cardiac history (+) with a history of ring fitting in 2006
Medication history:
- Candesartan 1x16 mg
- Bisoprolol 2.5 mg (1x1.5)
- Metformin 2x500 mg
- UDCA 2x250 mg
- Folic acid 2x2 mg
- CPG 1x75 mg
- Simvastatin 1x20 mg
- Allopurinol 1x100 mg
- Mecobalamin 1x500 mg
- Warfarin 1 x 2 mg
- Spironolactone 1x25 mg
- Furosemide 1x20 mg
- Insulin glargine 1x8 units (SC)
Present Status Left Lower Extremity
Awareness : Compos mentis L: visible wound (+) gangrene (+) digiti I-V pedis S size
General condition : weak 15cm x 10cm Skin base, Pus (-)
BP : 110/70 mmHg F : Tenderness (+), feels cold
HR : 84 x/min M: Pain limited ROM
Temp : 36.5 C
SpO2 : 98% on room air
VAS : 3/10 Right and Left Lower Extremity Pulsation
A. Femoral ++/++
Weight : 64 kg A. Poplitea +/+
A.Tibialis posterior +/-
General Status: A. Dorsalis pedis +/-
Eyes: anemic -/-, jaundice -/-
Thorax: Right and Left Lower Extremity Saturation
- Cardiac : S1S2 single regular, murmur (-) R : 95/96/96/97/95
- Pulmo : Ves+/+, rh -/-, wh -/- L : -/-/45/-/-
Abdomen: Normal (-), bowel sounds (+) distension (-) ABI 0.9/sde
Extremity: ~ local status
Pedis Score
Local Status P : +1
Right Lower Extremity E : +2
L: Ulcus (+) Edema (-), erythema (-) D : +2
F : Tenderness (-), felt warm (+), CRT <2 seconds I : +2
M : Normal active/passive ROM S:0
Clinical Appearance
Laboratory Results 31/05/2023 Prof Ngoerah Hospital
Chest X-Ray 31/05/2023 Prof Ngoerah Hospital

Impression:
- Aortosclerosis
- Obs. Single lower zone nodule right lung dd/ round
pneumonia
- Left pleural effusion
- Thoracic spondylosis
Foot X-Ray 31/05/2023 Prof Ngoerah Hospital
Impression:
- Impressive Charcot joint pedis sinistra
- Osteopenia
- At present there are no visualized bone
fractures or joint dislocations
DIAGNOSIS MANAGEMENT
• Bilateral lower extremity CLTI Rutherford grade IV - Pro CTA + C bilateral inferior extremities (arterial phase and
venous phase)
• DM type 2 - Wounds care periodically
• ACKD due to susp pre renal on CKD ec susp DKD
dd NS Intenna Division
• CAD - IVFD NaCl 0.9% 1500 ml/24 hours
- Diet DM + CKD 1900 kcal/day + Protein 0.8 gr/kgBB/day
- Paracetamol 750 mg every 8 hours
- Insulin Glargine 10 units every 24 hours (SC)
- Glulisine insulin 4 units every 10 minutes before the main meal (SC)
- Candesartan 16 mg every 24 hours (intraorally)
- Bisoprolol 2.5 mg every 24 hours (intraoral)
Check
- HbA1C

ICD 9
ICD 10
88.01. Computerized Axial Tomography
I99.8 chronic limb-threatening ischemia NOS of native arteries of extremities
I25.812 Atherosclerotic heart disease of native coronary artery with angina pectoris with 879.8 Wound Care
documented spasm 99.2 Injection or infusion of other therapeutic or prophylactic substance
N18.9 Chronic kidney disease V58.69 The use of other medication
E11.42 Other specified diabetes mellitus 99.21 Injection of antibiotic
99.07 Transfusion of Nonautologous Serum Albumin
Z79.891 The use of analgetic
 Medical Emergency Ward Bed 6
I Nyoman Nuada / M / 64 y.o / 01172936 / BPJS
Referral patient from Internal medicine division to trauma surgery division

Chief Complaint :
Pain in the lump around the anus

Present Illness
The patient came with complaints of pain in the lump around the anus since 3 days ago, he just felt the pain, the pain
felt worse if he was in a supine position and improved if he was positioned slightly to the side, and there had been a
wound and pus coming out of the wound since this afternoon. Denied lumps elsewhere. Patients also complain of feeling
weak, complaining of fever (-), nausea (-), vomiting (-) adequate appetite (+) Defecation (+) Normal, , urinate (+)
Past Illness:
- DM since > 15 yrs, sansulin therapy 1x18 IU, Apidra 3x8 IU SC
- History of heart disease since 5 years ago, last heart attack in January 2023.
- History of ring installation but failed in 2022

History of Treatment:

Cardiac Therapy:
• drochlorothiazide 1x12.5mg PO
• atorvastatin 1x20mg PO
• Furosemide 2x40mg PO
• miniaspi 1x80mg PO
• clopidogrel 1x75mg PO
• allopurinol 1x300 mg PO
• nitrocaf 2x100mg PO
Present Status RT:
Awareness : Compos mentis TSA (+) strong, rectal ampulla not collapsed, mucosa smooth, fistula
General condition : moderate not palpable, mass palpable (-),
HS: blood (-), faeces (+) brown color
BP : 130/70 mmHg
HR : 87 x/min
Temp : 37.1 C
SpO2 : 99% on RA
VAS : 2/10

General Status:
Eyes: anemic -/-, jaundice -/-
Thorax: Symetrical
A:
- Pulmo : Ves +/+ rh -/- Wh -/-
- Cardiac: regular single S1S2
Abdomen: Normal (-), bowel sounds (+) distension (-)
Extremity: warm +/+, edema -/-

Local status
Perianal Region
A lump appears (+) clockwise 5 ± 6 cm from the anal verge measuring
3x1 cm, feels warm, fluctuating (+), pus production (+) tenderness (+)
redness around (+)
Clinical Appearance
Laboratory Results 31/05/2023 Prof Ngoerah Hospital
DIAGNOSIS MANAGEMENT
• Perianal abscess - Incision + Drainage Abscess at Emergency Operating Theater
• ACKD ec susp prerenal on CKD ec susp DKD
• Hyperglycemia (370) Internal medicine division
• DM type 2 IVFD Nacl 0.9% 20 tpm
• CCAD 3VD (CTO at LAD) - CKD diet 2000 kcal/day + protein 40gr/day
- Omeprazole 40 mg every 12 hours IV
- metoclopramide 10 mg every 8 hours IV
- Sansulin 1x18 IU every 24 hours SC
- Apidra 3x8 IU SC 10 minutes before eating SC
- drochlorothiazide 1x12.5mg PO
- atorvastatin 1x20mg PO
- Furosemide 2x40mg PO
ICD 10
K59.9 Perianal abscess
- miniaspi 1x80mg PO
E11. 621 Type 2 diabetes mellitus with foot ulcer - clopidogrel 1x75mg PO
I25.812 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
N17.9 Acute kidney failure, unspecified - allopurinol 1x300 mg PO
E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease - nitrocafe 2x100mg PO

ICD 9
86.04 Other Incision With Drainage Of Skin And Subcutaneous Tissue
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
99.21 Injection of antibiotic
Z79.891 The use of analgetic
 Surgical Emergency Ward Bed 2
I Nyoman Musko/ M / 63 y.o / 23028892/ BPJS
Referral patient from Klungkung Hospital to BTKV & Orthopedics Division with Multiple Fr. Costa Dextra + CF Clavicula Dextra

Chief Complaint :
Right chest pain

Present Illness
The patient came conscious in an ambulance with complaints of pain in the right chest after the patient fell from a jackfruit tree 2 days
after SMRS. The pain feels better with the administration of anti-pain drugs, and gets worse when you take a breath, shortness of
breath (-). He denied history of fainting, hitting his head, nausea and vomiting. Denied pain in the spine.
MOI : The patient climbed a jackfruit tree 5 meters high and then fell to the right with his right chest hitting the ground first.

Past Illness:
- History of HT, DM and heart disease denied

History of Treatment
Klungkung Hospital
Petidine 100mg + Ketorolac 60mg in 500cc D5% finished in 24 hours
Cefoperazone 1gr every 12 hours iv
Present Status Local status
Awareness : Compos mentis Right hemithorax region
General condition : moderate I: Symmetrical chest wall movement (+) injury (-)
BP : 140/80 mmHg P: VF +/+, tenderness (+), crepitus (+) clavicle & ribs
HR : 67 x/min 3,4,5,6,7,8 left
Temp : 36.6 C Appears to have a chest tube attached to the right
SpO2 : 99% on FM 6 lpm hemithorax, function (+), fogging (+), undulation (-)
VAS: 3/10 Q: Sonor +/+
A: Cast: S1S2 single, regular, nut (-)
General Status: Pulmo : Ves +/ + , Rh -/-, Wh -/-
Head : Cephalhematome (-)
Eye : Hematome periorbita -/- anemic -/-, jaundice -/-
Maxillofacial : scar (-), otorhe (-) rhinorea (-)
Neck: scar (-)
Thorax : ~ Local status
Abdomen : Distensi (-) BU ((+) 6-8 x/menit
Ext : warm +/+, CRT< 2s, edema +/+
Clinical Appearance
Laboratory Results 31/05/2023 Prof Ngoerah Hospital
Laboratory Results 30/05/2023 Klungkung Hospital

WBC 17.75/ HGB 14.3/ PLT 180/ GDS 149pH

7.40/ PCO2 41.3/ PO2 229/ HCO3- 25.5/ TCO2
27.0/ BE(B) 1.0/ SO2 100.0/ FiO2 45.00
Chest X-Ray 30/05/2023 Klungkung Hospital
Head CT Scan 30/05/2023 Klungkung Hospital
DIAGNOSIS MANAGEMENT
• Right pneumothorax post insertion of the right chest tube • WSD Suction Active -15mmHg
(05/30/2023) • IVFD NaCl 0.9% 20 dpm
• Fracture Costa Multiple 3-8 Right Posterolateral Aspect with • Pain Management with Pethidine 100mg + Ketorolac 60mg in D5%
Complications 500 cc in 24 hours
• Right subcutis emphysema • Cefoperazone 1gram every 12 hours IV
• Close Clavicle fracture right Middle 1/3 Allman Group 1 • Observation for production + WSD function
• Observation for signs and symptoms of respiratory distress and the
expansion of subcutaneous emphysema
• Treat periodic injuries
• Consult to Orthopedics division for the management of Fr. Clavicula
Dextra

• POC : Pro clipping costae urgent

Orthopaedic Region
ORIF-PS (Clavicle) (elective)

ICD 10
S22. 49 Multiple fractures of ribs ICD 9
J93.9 Pneumothorax 34.04 Insertion of intercostal catheter for drainage.
J43. 9 Emphysema 99.2 Injection or infusion of other therapeutic or prophylactic substance
S42. 0 Fracture of clavicle V58.69 The use of other medication
Z79.891 The use of analgetic
99.21 Injection of antibiotic
79.02 Clipping costae
 Surgical Emergency Ward Bed 1
Lukas Ely / M / 29 yo / 23028901 / BPJS
Tacc 01/6/23 (01.00 WITA); Tarr 01/6/23 (01.34 WITA); TRISS 99.25%; RTS 7.8408; ISS 12

Chief Complaint :
Abdominal pain

Present Illness
The patient came to his senses, was escorted by BPBD complaining of pain in the stomach since 1 hour ago
after having a traffic accident. Pain is said to be persistent. The patient also complains of pain in the
scrotum. Unconscious history denied.

MOI :
The patient, a motorbike rider, wearing a helmet, was hit by another motorbike from the right side and fell with an
unknown mechanism
Primary Survey Extremities: warm acral (+/+) oedem (-/-),
A : Clear, C-Spine is stable
B : Spontaneous, RR 20 x/m, SpO2 98% on FM 8lpm Local Status
C: Abdomen
- BP: 70/40 mmHg loading RL 1000 cc -> 100/70mmHg I : Distention (-), injury (+) LLQ.
- HR : 115x/m lift strength, CRT < 2 seconds. A : Bowel sound (+) 6-8x/min
- Obtained perianal lacerations: active bleeding (+) --> P : Supel, tenderness (-), palpable crepitus in the left lower
tampons 2 Gauze, controlled bleeding. abdomen
- Unstable pelvis: pelvic binder installed --> stable Q: Timpani
D : GCS E4V5M6. Isocho pupil, reflex pupil +/+. Extremities: warm +/+// +/+
Lateralization effect (-)
E : Tax 36.7 C R. Flank D
L : Vulnus excoriatum (+) size 5x6cm, active bleeding (-).
Secondary survey: F : Pressure Pain (+)
Head: open wound left frontal region 3x4cm in size,
stitched (+) R. Perianal
Eyes: anemic -/-, icterus -/-, pupillary reflex +/+, L: Vulnus appertum (+), direction at 11 o'clock, size -+
ENT: otorea (-), rhinorrhea -/- 4x1cm, basis difficult to evaluate, gauze tampon (+), active
Neck: meningeal sign (-), wound (-) bleeding (-)
Thorax: symmetrical +/+, wound -/- RT: TSA (+) weak, mucosa smooth, palpable wound at 11
pulmo: ves+/+, rh-/-, wh -/-, cardio: single S1S2, Murmur o'clock, seepage (+)
(-)
Abdomen: wound (-) supple, bowel sounds (+) normal
Clinical Appearance
Clinical Appearance
Laboratory Results 01/06/2023 Prof Ngoerah Hospital
Laboratory Results 01/06/2023 Prof Ngoerah Hospital
Chest X-Ray 01/06/2023 Prof Ngoerah Hospital

- Cor and pulmo no

abnormalities
- At present there are no
visualized bone fractures or
joint dislocations
Neck X-Ray 01/06/2023 Prof Ngoerah Hospital

- Pacervical muscle
spasms
- Currently there is
no visible
compression/fracture
Pelvic X-Ray 01/06/2023 Prof Ngoerah Hospital

- No bone fractures or joint

dislocations were seen in the
pelvic region
- Pubic symphysis diastasis
- Soft tissue swelling in the
right Hip region
 FAST 01/06/2023 Prof Ngoerah Hospital

Negatif
DIAGNOSIS
• Rapid response hypovolemic shock
• Pelvic Ring Injury (Open book fracture)
• Post stabilization with pelvic binder
• Suspect rectal laceration dd/Rupture
ICD 10
R57.1 Hypovolemic shock
S32.810A Multiple fractures of pelvis
K63 .1 - Perforation of intestine
MANAGEMENT
- Explore Anus with Rectoscopy Join Op Orthopedic division at
Emergency operating room
- IVFD NS 20 dpm
- Ketorolac 30 mg/ 8 hours IV
- Ceftriaxone 1gr/12 jam IV
- Pelvic stabilization according to Orthopedic division
Orthopaedic Division
Pro Debridement + External Fixation anterior frame at Emergency
Operating room
ICD 9
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
Z79.891 The use of analgetic
99.21 Injection of antibiotic
48.2 Diagnostic procedures on rectum, rectosigmoid and perirectal tissue
 Isolation Emergency Ward Bed 1
Ni Ketut Sinta Aprianti / F / 10 y.o / 23028903 / BPJS
Patients referred from Balimed Hospital to Ts General Surgery with Lumbar Abscess S e.c. susp TB dd/malignancy + massive
pleural effusion S + mild anemia for further treatment

Chief Complaint :
Lump on back

Present Illness
patient with complaints of a lump on the back that has been felt for about 2 months, initially the lump was the size of a
marble, over time the lump has grown to the size of an egg, the lump has broken since 3 days and the pain is getting
worse, the lump is accompanied by pain and discharges pus for about 2 day. History of fever (+) and cough for the past
3 months, intermittent, but now there is none. Shortly denied. Weight loss (+)
Defecation (+) and Urinate (+)

Past Illness:
- The patient has never had a similar complaint (-)
- Other systemic diseases
Present Status
Awareness : Compos mentis
General condition : moderate
BP : 110/70 mmHg Local status
HR : 87 x/min Left flank region
Temp : 36.6 C L: Looks like a lump (+) size -/+ 5x5 cm, firm
SpO2 : 99% on RA boundaries, hyperemia (+),
Weight 23 kg F : tenderness (+), fluctuating (-), feeling warm (+) pus
(+)
General Status:
Head : normocephalic (+)
Eye : anemic -/-, jaundice -/-
ENT : normal (+)
Neck: scar (-)
Thorax
symmetrical +/+, wound -/-
pulmo: ves+/+, rh-/-, wh -/-,
cardio: single S1S2, Murmur (-)
Abdomen : Distensi (-) BU ((+) 6-8 x/menit
Ext : warm +/+, CRT< 2s, edema +/+
Clinical Appearance
Laboratory Results 30/05/2023 Balimed Denpasar
Hospital

WBC 18.76 / HGB 9.2 / HCT 30.6 / PLT 667

Laboratory Results 1/06/2023 Prof Ngoerah Hospital
Chest X-Ray 30/05/2023 Klungkung Hospital
Impression :
Suspicion of left pleural effusion With signs of
left lung collapse cannot be ruled out by the
presence of pneumonia in the upper left lung
field
Right pneumonia
Left extrathoracic calcified mass
The heart is difficult to evaluate
Chest X-Ray 30/05/2023 Prof Ngoerah Hospital

Impression:
- Massive left pleural effusion
- Impresses a soft tissue mass with a calcified
component in it in the left hemithorax region
DIAGNOSIS MANAGEMENT
• Left flank region tumor with secondary infection due to suspected • Pro Thoracostomy Chest Tube Insertion - LeftWSD + Abscess
TB Drainage Incision in Emergency Operating Room-
• Massive left pleural effusion • Pus culture + examination of PA tissue
• Mild Anemia (9.2) • Educate Patient's Family
• Leukocytosis (18.76) • Pre Op
• Thrombocytosis (667)
Anesthesia Division
ASA III

Pediatric Division
- Patient will be followed up further by TS Pediatric Respirology
Division
- Further investigation of TB suspicion
- Advice X-Ray lateral decubitus, evaluation of pleural effusion
- if an incision is made, suggestions for abscess culture, abscess tissue
ICD 10
D17.1 Benign lipomatous neoplasm of skin and subcutaneous tissue of trunk cytology and wound bed and TCM Abscess
J90 Pleural effusion
D64. 9 Anemia

ICD 9
34.04 Insertion of intercostal catheter for drainage.
87.44, X-Ray Of Routine Chest
V58.69 The use of other medication
 Medical Emergency Ward Bed 14
I Nengah Ardika / M / 37 y.o / 23017954 / BPJS
The patient was consulted by Interna division with abdominal pain due to suspected ileus obstruction

Chief Complaint :
Heartburn

Present Illness
The patient is conscious complaining of heartburn which has been felt since 1 week ago. Pain is felt up to the right
upper abdomen and intermittent. The patient has had the same complaint since the last 1 year. The patient also
complained of pain in the lower back since 1 week ago, the pain was felt to the point where it was difficult for the patient
to move. Complaints about changing pattern of bowel movements previously denied, small bowel movements such as
goat droppings (-), diarrhea (-), last bowel movements this morning, last flatus this afternoon, fever (-), tightness (-)The
patient also complained of discharge filled with fluid on the face and body which had been felt since 2 weeks.
Complaints are accompanied by itching and have broken. Appetite is said to decrease.
 History of Treatment:
Past Illness:
- Paracetamol 500 mg tiap 8 jam PO
- Patients with a history of aplastic anemia
- Methylprednisolon 8mg tiap 12 jam PO
- HT (-), DM (-), heart disease (-)
- Acyclovir 800mg tiap 4 jam PO
Present Status Local Status
General condition : moderate Abdomen Region :
GCS : E4V5M6 I. Distension (-), Darm contour (-), Darm steifung
BP : 130/80 mmHg (-), Mass (-)
HR : 93 x/min A. BU (+) 6-8x/minute.
Temp : 36.7 C P. Supel (+), Epigastric tenderness (+), Defans (-)
RR : 20 x/min P. Tympani
SpO2 : 98% on Room air
RT :
General Status: TSA (+), recti ampulla not collapsed, mucosa
Head : normocephaly smooth, no mass palpable, tenderness (-)
Eyes: anemic +/+, jaundice -/- HS: feces (+), mucus (-), blood (-)
Thorax:
- Cor : S1 S2 single regular, murmur (-)
- Pulmo : Ves +/+ rh -/- wh -/-
Abdomen : soepl, bowel sound (+) normal,
defans (-), tenderness (-)
Extremity :warm, CRT < 2 second, edema -/-
Clinical Appearance
Clinical Appearance
Laboratory Results 31/05/2023 RSUP Ngoerah Hospital
Abdomen X-Ray 31/05/2023 Karangasem Hospital
Abdomen X-Ray 31/05/2023 Karangasem Hospital
Abdomen X-Ray 31/05/2023 Karangasem Hospital
DIAGNOSIS MANAGEMENT
• Observation for Abdominal Pain ec susp erosive • Currently there are no signs of obstructive ileus, no specific therapy in the field of
gastritis digestive surgery
• Hematemesis due to suspected erosova gastritis • Other therapy according to Interna division
• Aplastic Anemia • Proposed EGD examination
• Suspected Varicella zoster • Keep the NGT
• Fleet enemas every 12 hours
• Observation of complaints, VS, signs of acute abdomen

ICD 10
K29.60 -Other gastritis with bleeding
D61. 9 Aplastic anemia
B02.8 Zoster with other complications
ICD 9
99.2 Injection or infusion of other therapeutic or prophylactic substance
V58.69 The use of other medication
Z79.891 The use of analgetic
99.21 Injection of antibiotic