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CHF + Gagal ginjal + Susp.TB paru +efusi pleura bilateral
Gilang
PembimbingDr. Silman H, Sp.Rad, MH.es
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IDENTIFIKASI PASIEN
!ama leng"ap # B$G%&'
(enis "elamin # Pria
)mur # * tn$gama # %slam
Status per"a-inan # Meni"a
Pendidi"an # SDPe"erjaan # buru
$lamat # !atar
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ANAMNESIS
• Diambil dari # $llanamnesa
• Tanggal # / $gustus 012
•
(am # 0. 3%B• eluan utama # 's datang dengan
sesa" sema"in memberat seja" 1
bulan 4ang lalu
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eluan tambaan
• Batu", sulit tidur, muda lela, tida"nafsu ma"an, BB turun, n4eri uluati, "edua "a"i benga"a",
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• 'S datang "e RSPB$ dengan "eluan sesa" 4ang dirasa"ansema"in memberat seja" 1 bulan 4ang lalu. Sesa"dirasa"an terutama setela mela"u"an a"ti5itas, s jugameara sesa" ji"a berjalan suda lebi dari 2 meter. Selainsesa" s jga mengelu batu" seja" lama. Saat malam"eti"a tidur s sering terbangun "arena sesa" dan batu",seingga s arus tidur mengguna"an 0 bantal. 's jugasempat merasa"an "edua tungga"i "a"i membeng"a".)ntu" batu" s menga"u belum perna berbat danri-a4at minum bat 6 bulan disang"al. 's merasa beratbadan terus menurun, tida" nafsu "an seja" lama dan n4eriulu ati. Se"itar 0 minggu 4ang lalu s sempat dira-at dipus"esmas dan tida" membai". Di"eluarga mengalami al4ang sama disang"al.
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RIWAYAT PENYAKIT SEKARANG
RIWAYAT PENYAKIT DULU
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$namnesa Sistem
• Dada- Nyeri dada Sesak nafas
Berdebar - Batuk darah
Ortopnoe Batuk
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$bdmen- Rasa kembung - Perut membesar
- Mual - Wasir
- Muntah - Mencret
- Muntah darah - Tinja berdarah
- Sukar menelan - Tinja berwarna dempul
Nyeri perut/nyeri ulu hati - Tinja berwarna ter
- Benjolan
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7"stremitas
Bengkak(eks. Inferior) - Deformitas
- Nyeri sendi - Sianosis
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• Berat badan rata8rata 9"g: # ** "g
• Tinggi badan 9;m: # 12< ;m
•
%MT # 1/,6 "g=M0RIWAYAT MAKANAN
• Fre"uensi= ari # 0>= ari
•
(umla= ari # satu prsi• ?ariasi= ari # ber5ariasi
• !afsu ma"an# "urang
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• PEMERIKSAAN FISIK
• Pemeri"saan )mum
• Te"anan dara # 11=< mmHg
• !adi # 11* >=menit
• Suu # @6.<AC
• Pernapasan # @ >=menit
• eadaan gii # "urang
• esadaran # ;mps mentis
• Siansis # tida" siansis
• 7dema umum # 7dema Tung"ai9minimal:
• Cara berjalan # nrmal
• Mbilitas 9a"tif=pasif: # pasif
• Te"anan 5ena jugularis # 2 + 0 ;m
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Paru8Paru
• %nspe"si, "iri # simetris, retra"si 9 :, spiderne5i98:simetris
• anan # simetris, retra"si 9 :, spiderne5i98:simetris
• Palpasi, fremitus "iri"anan
• Per"usi, "iri # snr dan aga" redup padabagian ba-a paru anan # snrdan aga" reduppada bagian ba-a paru
• $us"ultasi,"iri #5esi"uler, Rn"i basa selurulapang paru
anan # 5esi"uler, Rn"i basa seluru lapang paru
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(antung
• %nspe"si # i;tus "rdis ta" tampa"
• Palpasi # i;tus "rdis teraba
• Per"usi
• iri # atas, i;s %% linea sternalis sinistra
• Ba-a, i;s ?%% linea sternalis sinistra
• anan # atas, i;s %% linea sternalis de>tra
• Ba-a, i;s ?%% linea sternalis de>tra
• $us"ultasi # bun4i jantung 9 gallp:
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ABDOMEN
• %nspe"si # dinding perut dinding dada,distended 98:, 5ene"tasi98:, ;aput medusa98:, i"teri" 98:.
•
Palpasi # n4eri te"an 9+: regi epigastrium• Hati # ta" membesar
• Eimpa # tida" teraba
• Ginjal # n4eri "et" ;5a 98:
• Per"usi # timpani
• $us"ultasi #peristalti" 9+: *>=menit, bruitepar 98 :, bruit epigastrium 98:
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Pemeri"saan Penunjang
Trombosit 101.000
1!-"00 u#
Asam rat !"#
$k % ! m&/dl
Wn %'"'m&/dl
rea '(
#)-() m&/dl
*reatinin +")
$k )",-#"' m&/dl
Wn )"!-#" m&/dl
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Ft tra"s
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Hasil
C'R
• (antung tampa" membesar "e lateral "iridan"anan dengan ape> tertanam pada
diafragma.• Pinggang jantung mendatar dengan
9CTR2:
• Sinus ;stpreni;us bilateral tertutup
perselubungan• Sinus ;ardipreni;us bilateral "abur
• Diafragma bilataral tertutup perselubungan
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P)EM'
• Hilus "anan dan "iri "abur
•
Cra"an brn"5as"uler bertamba• Tampa" perber;a"an luna" diperiiler
bilateral
•
Tampa" perber;a"an luna" dilapangtenga8ba-a paru "anan danlapang atas paru "iri
• Tampa" perselubungan pa"m en di emitra"s lateral
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SE7T$E9S'FT T%SS)7:
• Dalam batas nrmal
7S$!
• ardimegali 9all8;amber: disertai edemparu
• Radilgis tampa" menunju"an adan4a Pa"tif, perlu dipertimbang"an 9bagaimana
dengan "linis dan Eab:• 7n;apsulated eIusi bilateral, DD# TB paru
De;m ;rdis
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D%$G!'S%S 7R($
• CHF + Gagal ginjal + TB paru + efusipleura bilateral
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