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LAPORAN KASUS KEMATIAN
Nama : Tn.S RS : RSUH
Umur : 50 tahun Ruangan : ICU
Alamat : Buton No.Register : 0381!
"e#er$aan : "ega%ai &antor Tgl.'RS : 10 A(ril 015
Agama : Islam Tgl meninggal : 13 A(ril 015
Su#u : Bugis )o#ter Ruangan : *r. No+erio Taru#allo
Status (er#a%inan : su*ah meni#ah Chie, Ruangan : *r. Al*ian )ahlan
Anamnesis (Autoanamnesis)
Ri%a-at "en-a#it Se#arang
Keluhan Utama : lemas badan
"asien *i#onsul #e agian /n*o#rin metaoli# *ari agian e*ah *igesti, *engan #eluhan
lemas a*an -ang ti*a# *isertai #eringat *ingin -ang *ialami hari tera#hir *engan )S:2 mg4*l
*an )":18 mg4*l *ari anamnesis leih lan$ut *i#etahui ah%a (asien memili#i ri%a-at )' -ang
su*ah *i*erita (asien se$a# tahun 003 meng#onsumsi glien#lami* namun *i#onsumsi se6ara ti*a#teratur oleh (asien. "asien ti*a# memili#i ri%a-at mengguna#an insulin. Seelum (asien mengetahui
ah%a (asien men*erita )' (asien sering an-a# ma#an *an an-a# minum namun ti*a# *isertai
(ening#atan erat a*an -ang sesuai.(asien $uga sering BA& terutama malam hari 57 4hari
"asien masu# rumah sa#it (a*a tanggal 8727015 *engan ru$u#an *ari RSU) Bau7Bau
*engan #eluhan sulit BAB *an (erut *irasa#an tam(a# memesar se$a# minggu seelum masu#
rumah sa#it mual *an muntah a*a. )ari hasil (emeri#saan Ra*iologi *i RSU) Bau7Bau *i#ata#an
(asien men*erita #an#er usus lalu (asien *iru$u# #e ma#assar *an #emu*ian men$alani o(erasi *i
RSUH (a*a tanggal 9727015.
"asien $uga mengeluh atu# -ang ersi,at hilang timul *isertai *aha# -ang er%arna $ernih*an #ental -ang su*ah erlangsung se$a# tahun tera#hir. "enurunan erat a*an 8 #g *alam
ulan tera#hir #eringat malam ti*a# a*a ri%a-at eroat AT ti*a# a*a n-eri *a*a *irasa#an (asien
$i#a (asien atu# ri%a-at atu# *engan *aha# er6am(ur *arah ti*a# a*a sesa# na,as ti*a# a*a
Riwaat Pena!it Te"dahulu:
Ri%a-at (ernah mengalami lu#a (a*a tung#ai seelah #anan -ang ti*a# #un$ung semuh (a*a
tahun 005 *an harus #ontrol se6ara teratur *i (oli e*ah RSU) Bau7Bau untu# men$alani
(era%atan lu#a selama setahun
Ri%a-at (en-a#it $antung *isang#al
Ri%a-at n-eri *a*a seelumn-a ti*a# a*a Ri%a-at eroat AT *isang#al
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Ri%a-at (ernah ter#ena in,e#si (aru *isang#al
Ri%a-at hi(ertensi *isang#al
Ri%a-at gangguan gin$al *isang#al
Ri%a-at men$alani #emotera(i *isang#al
Riwaat Kelua"#a:
A-ah :su*ah meninggal (a*a umur 0 tahun (en-ea ti*a# *i#etahui
Iu :su*ah meninggal (a*a umur !5 tahun (en-ea ti*a# *i#etahui
Sau*ara:(asien ana# #e73 *ari 5 ersau*ara 1 sau*ara su*ah meninggal (en-ea ti*a#
*i#etahui (asien memili#i sau*ara (erem(uan -ang $uga men*erita )'*an se#arang rutin
eroat
Ana# :(asien memili#i 3 orang ana# -ang masih hi*u( *an sehat
Ri%a-at #an#er *alam #eluarga ti*a# a*a
Riwaat P"ibadi:
"asien memili#i ri%a-at #eiasaan mero#o# se$a# usia mu*a *an rata7rata meng#onsumsi 17
ung#us4hari
Ri%a-at gemar meng#onsumsi *aging ti*a# a*a
PEMERIKSAAN $ISIK
&esan sa#it :sa#it se*ang
i;i :6u#u(
Tinggi a*an :153 6m
Berat a*an :28 &g I'T :19 #g4m
&esa*aran :Com(os mentis
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Thora#s
"aru:
I :(ergera#an rongga thora#s asimetri#s (ergera#an (aru #iri tertinggal ti*a# tam(a#
barrel chest
" :ta#til ,remitus (aru #iri menurun setinggi ICS = (aru #anan menurun setinggi ICS=I
" :(er#usi re*u( setinggi ICS = (a*a hemithora#s sinistra *an setinggi ICS =I (a*a
hemithora#s *etra
A :Bun-i (erna(asan ron#ho+esi#uler %hee;ing ti*a# a*a +o#al ,remitus (aru #iri
menurun setinggi ICS = *an (aru #anan menurun setinggi ICS =I
antung:
I :i6tus 6or*is ti*a# terlihat
" :i6tus 6or*is teraa (a*a linea mi*6la+i6ularis ICS = #iri
" :(e#a# atas $antung #esan normalA :un-i $antung I *an II murni reguler un-i tamahan ti*a# a*a
A*omen:
I :*atari#ut gera# na,as tam(a# lu#a o(erasi tam(a# ter(asang *rain #e 6olostom- ag
A :"eristalti# #esan menurun
" :tim(ani n-eri #eto# ti*a# a*a
" :tim(ani n-eri te#an (a*a regio inguinal *e#stra *an sinistra he(ar *an lien ti*a#
teraa memesar n-eri te#an ti*a# ti*a# a*a
/#stremitas :oe*em (retiial ?4? a#ral hangat (ulsasi arteri *orsali (e*is *e#stra *an sinistra ?4?
tam(a# e#as lu#a (a*a *aerah (e*is *e#stra
&ulit :sa%o matang turgor normal i#teri# ti*a# a*a
Peme"i!saan Penun%an#:
Peme"i!saan &olon in Loo' (*+,-):
&esan:Tumor Colon trans+ersum (roimal
.a"ah "utin (/*+,-):
BC :8904u@RBC :28010!4u@
H :11g4*l
Ht :3!1
'C= :5 ,l
'CH :5 (g
T6 :!80004u@
Neutro,il :89
ANC :!2!9
EK0 (/*+,-):
Irama sinus
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Reguler
HR:8 4menit
Normoais *e+iation
$oto tho"a1 (2*+,-):
/,usi (leura ilateral
Peme"i!saan hemostasis (2*+,-)
BT :3
CT :8
"T :133
A"TT :1
INR :10
Peme"i!saan !imia da"ah (2*+,-):
)S :2 mg4*lST :3 u4@
S"T :38 u4@
Alumin : gr4*l
Ureum :3 mg4*l
&reatinin :1 mg4*l
.a3ta" masalah:
,4.M ti'e * non obese
*4Tumo" &olon 'ost o' 5emi6ole6tom de1t"a7Illeostom
84E3usi 'leu"a bilate"al
45i'oalbuminemia
Pen#!a%ian:
1.)i(i#ir#an )' ti(e #arena *ari anamnesis *i#etahui (asien telah men*erita )' se$a# tahun 003
*engan ri%a-at meng#onsumsi glien6lami*e *engan )S 2 mg4*l *imana seelum (asien
ter*iagnosis men*erita )' ter*a(at a*an-a ge$ala trias )' (a*a (asien -aitu (ol-uria (ol-*i(si
(ol-,agi *isertai )S D 00 mg4*l. )imana *iagnosis )' *a(at *itega##an a(aila a*a ge$ala 3" *an
)SD00 mg4*l
Ren6ana dia#nosti!: 'onitoring )S (remeal (sm
"eri#sa )""
)"
"ro,il li(i*
Urinalisis rutin
HA16
Ren6anan te"a'i:
7Beri#an insulin *ri( sesuai (roto#ol
"eri#sa )S4$am
)S D 300 eri#an ! U4$am )S 007300 eri#an 3 U4$am
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)S 100700 eri#an 15 U4$am
)S E !0 sto( *ri( insulin
Target )S 1207180 mg4*l
7)iet )' 100 ##al4hari
.)i(i#ir#an tumor 6olon #arena *ari anamnesis *i*a(at#an #eluhan sulit BAB *engan (erut -ang
tam(a# memesar se$a# minggu tera#hir *engan hasil (emeri#saan 6olon in @oo( *i*a(at#an
#esan:tumor 6olon trans+ersum (ro#simal
Ren6ana te"a'i:
Sesuai tera(i Teman se$a%at agian e*ah *igesti,
3.)i(i#ir#an e,usi (leura ilateral #arena (asien (a*a (emeri#san ,isi# *i*a(at#an (er#usi re*u( (aru
#iri setinggi ICS = *an (aru #anan setinggi ICS =I *an (a*a ,oto thora *i*a(at#an e,usi (leura
ilateral
Ren6ana dia#nosti!:
"emeri#saan s(utum BTA 3 gram $amur "ungsi 6airan (leura
"emeri#saan @)H serum *an (rotein total
Analisa *an sitologi 6airan (leura
@/)
Ren6ana te"a'i:
"un#si 6airan (leura
Usul #onsul agian (ulmonologi
2.Hi(oaluminemia *i(i#ir#an #arena *ari hasil la *i*a(at#an #a*ar alumin
Ren6ana dia#nosti!: ST
S"T
Ur
Cr
"rotein total
Ren6ana te"a'i:
"emerian alumin 0 1 otol42 $am
$ollow u'
10727015
0!.30
Interna
TT=:
T):1384! mmHg
N:84menit
R:194menit
S:3!!0C
Sa:9
Pe"awatan I&U ha"i I
1.)iaetes 'ellitus ti(e non
oese
S:
"asien mengeluh lemas mual
muntah
:
)S:305 mg4*l
Tera(i:
7Beri#an insulin *ri( sesuai
(roto#ol
)S D 300 eri#an ! U4$am
)S 007300 eri#an 3 U4$am
)S 100700 eri#an 15
U4$am
7Bila )S E!0 sto( *ri( insulin
*an (eri#sa )S (er $am
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./,usi "leura ilateral
S:
Batu# sesa#
:
"aru:(er#usi re*u( (a*a #e*ua
(aru setinggi ICS =I (aru
#anan *an setinggi ICS = (aru
#iri
Foto thora:
/,usi (leura ilateral
3.Tumor Colon Trans+ersum
(ost o( hemi6ole6tom- *etra
S:
N-eri (a*a *aerah lu#a o(erasi
:
=AS s6ore:5410
Ter(asang stoma
"eristalti# usus
@a:
BC:9290 890
Neutro,il:3 89
7Bila )SE100 mg4*l eri#an
$uga )10 500 66 2 t(m
7Target "enurunan lu#osa
)arah seesar 5075 mg4*l4$am
7)iet )' 1!00 ##al4hari
Ren6ana *iagnosti#:
)S (er $am
)" *an )""
HA16
)arah rutin
"ro,il li(i*
UrCr
/le#trolit
STS"T
Asam urat
Ren6ana tera(i:
Usul #onsul agian
(ulmonologi
Ren6ana )iagnosti#:
7Alumin
7"rotein total
7Ren6ana (un#si (leura
7"emeri#saan s(utum BTA 3gram *an $amur
7Ren6ana (emeri#saan @)H
serum *an (rotein total serum
7Ren6ana analisa 6airan (leura
7Ren6ana (emeri#saan
/6ho6ar*iogra(h-
Tera(i *ari TS Be*ah *igesti+:
7Ce,tria#son in$ 1 gr41 $am I=
7metroni*a;ole 500 mg48 $am
I=
7#etorola6 in$48 $am I=
7alan6e 6airan
7Ra%at @u#a
10727015
10.00/n*o#rin 'etaoli#
S:
@emas mual muntah Ri%a-at )' *ari tahun 003
Tera(i:
7Beri#an insulin *ri( sesuai(roto#ol
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ri%a-at meng#onsumsi
glien6lami*
:
)S:182 mg4*l (#l
13.00
)S:2 mg4*l (#l
.00
I'T: 2 #g4m
A:
)iaetes mellitus ti(e non
oese
)S D 300 eri#an ! U4$am
)S 007300 eri#an 3 U4$am
)S 100700 eri#an 15
U4$am
7Bila )S E !0 sto( *ri(
insulin *an (eri#sa )S (er
$am
7Bila )SE100 mg4*l eri#an
$uga )10 500 66 2 t(m
7Target "enurunan lu#osa
)arah seesar 5075 mg4*l4$am
7)iet )' 1!00 ##al4hari
11727015
0.00Interna
T):134!8 mmHg
N:8!4menit
R:04menit
S:3!!0C
Sa:98
Pe"awatan I&U ha"i !e*
1.)' ti(e non oese
S:
@emas mual muntah
:
HA16:91
)S:155 mg4*l
./,usi "leura ilateral
S:
Batu# sesa#
:
"aru:(er#usi re*u( (aru
ilateral setinggi ICS =II
3.Hi(oaluminemia
S:
&e*ua &a#i tam(a# eng#a#
:
"itting oe*em ?4?
Alumin:5 gr4*l
2.Hi(eruri6emia asim(tomati#
S:
N-eri sen*i ti*a# a*a
:Tan*a in,lamasi (a*a sen*i
Tera(i:
7*ri( insulin 15 U4$am
7Bila )SE100 mg4*l eri#an
$uga )10 500 66 2 t(m
7Bila )S E !0 sto( *ri(
insulin *an (eri#sa )S (er
$am
7)iet )' 1!00 ##al4hari
7Target )S 1207180 mg4*l
Ren6ana )iagnosti#:
7&ontrol )S43 $am
Ren6ana Tera(i:
Usul #onsul agian
(ulmonologi
Tera(i:
7Alumin otol 0 *ri( 1
otol4hari
7=I" alumin #a(sul 3
Tera(i:
7Allo(urinol ta 100 mg 11
7)iet ren*ah (urin
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'T"71 ti*a# a*a
Asam Urat:11 mg4*l
Cr:5 mg4*l
5.A&I (re renal Taha( I
))4A6ute on C&)
S:
Sesa#
:
Ur:100 mg4*l
Cr: 5 mg4*l
!.Anemia hi(o#rom mi#rositer
e6 6hroni6 *isease
))4*e,isiensi Fe
S:
@emas
:
&on$un6ti+a (u6at 747
@a:
H:109
'C= *an 'CH menurunRBC:23010! u4@
.Tumor Colon Trans+ersum
(ost o( hemi6ole6tom- *etra
S:
N-eri (a*a *aerah lu#a o(erasi
:
=AS s6ore:5410
Ter(asang stoma
"eristalti# usus
Hasil @a:
BC:890 1100
Neutro,il:89 881
@/):
am I:19 mm4$am
am II:52 mm4$am
ST: U4@
S"T:21 U4@
@)H:328 U4@
"rotein total:53 gr4*l
H)@:! mg4*l
Tera(i:
7NaCl 09 500 66 8 t(m
7)iet ren*ah (rotein 08
g4&gBB4hari
7)iet ren*ah garam gr4hari
7)iet ren*ah (urin
7Usul #onsul H
7Balan6e 6airan
Ren6ana *iagnosti#:
7(emeri#saan urinalisa
Tera(i:
Atasi etiologi *asar
Ren6ana *iagnosti#:
7Ren6ana (emeri#saan
FeTIBC,erritine reti#ulosit
7Ren6ana (emeri#saan A)T
Tera(i *ari TS Be*ah *igesti+:
7Ce,tria#son in$ 1 gr41 $am I=
7metroni*a;ole 500 mg48 $am
I=
7#etorola6 in$48 $am I=
7alan6e 6airan
7Ra%at @u#a
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@)@:80 mg4*l
&olestrol total:1 mg4*l
Trigliseri*a:9! mg4*l
/le#trolit:
Na:121 mmol4@
&:51 mmol4@
Cl:113 mmol4@
11727015
0.00
/n*o#rin 'etaoli#
S:
@emas ri%a-at )'
:
)":155 mg4*l
)S malam 185 mg4*l
A:
)iaetes mellitus ti(e non
oese
Tera(i:
7Beri#an insulin *ri( sesuai
(roto#ol:
7Bila )SD300 mg4*l *ri(
insulin ! unit4$am
7Bila )S 007300 *ri( insulin
3 unit4$am
7Bila )S E00 *ri( insulin15 unit4$am
7Bila )S E100mg4*l
tamah#an )10 2 t(m
7Bila )S E !0 mg4*l sto( *ri(
insulin
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0!.30
Interna
T):11242 mmHg
N:9!4menit
R:!4menit
S:3!20C
Sa:90
1.)iaetes 'ellitus ti(e non
oese
S:
"asien mengeluh lemas
:
)S:131 mg4*l
./,usi "leura ilateral
S:
Batu# sesa# :
"aru:(er#usi re*u( (aru
ilateral setinggi ICS =II
Foto thora:
/,usi (leura ilateral
3.Hi(oaluminemia
S:
&e*ua &a#i tam(a# eng#a#:
"itting oe*em 747
Alumin:5 gr4*l
2.Hi(eruri6emia asim(tomati#
S:
N-eri sen*i ti*a# a*a
:
Tan*a in,lamasi (a*a sen*i
'T"71 ti*a# a*a
Asam Urat:11 mg4*l
Cr:5 mg4*l
5.A&I (re renal Taha( I
))4A6ute on C&)
S:
Sesa#
:
Ur:100 mg4*l
Cr: 5 mg4*l
Tera(i:
)iet )' 1!00 ##al4hari
*ri( insulin 15 U4$am
Bila )SE100 mg4*l eri#an
$uga )10 500 66 2 t(m
7&ontrol )S43 $am
7Bila )S E !0 mg4*l sto( *ri(
insulin
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!.Anemia hi(o#rom mi#rositer
e6 6hroni6 *isease
))4*e,isiensi Fe
S:
@emas (er*arahan ti*a# a*a
:
&on$un6ti+a (u6at 747
@a:
H:109 113
'C= *an 'CH menurun
RBC:23010! U4@ 2210!
U4@
.Tumor Colon Trans+ersum
(ost o( hemi6ole6tom- *etraS:
N-eri (a*a *aerah lu#a o(erasi
su*ah mulai er#urang
:
=AS s6ore:3410
Ter(asang stoma
"eristalti# usus
@a:
)S:131 mg4*lBC:1100 11130 u4@
Neutro,il:89 80
Tera(i:
Atasi etiologi *asar
Tera(i *ari TS Be*ah *igesti+:
7Ce,tria#son in$ 1 gr41 $am I=7metroni*a;ole 500 mg48 $am
I=
7#etorola6 in$48 $am I=
7alan6e 6airan
7Ra%at @u#a
1727015
0.00
/n*o#rin 'etaoli#
S:
(asien mengeluh lemas
:
)S:131 mg4*l
A:
)iaetes mellitus t-(e non
oese
Tera(i:
)iet )' 1!00 ##al4hari
*ri( insulin 15 U4$am
Bila )SE100 mg4*l eri#an
$uga )10 500 66 2 t(m
7&ontrol )S43 $am
7Bila )S E !0 mg4*l sto( *ri(
insulin
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Stoma:,eses hi$au (e#at
)S:130
A:
"ost o( hemi6ole6tom- hari #e7
)' ti(e
'etroni*a;ole 500 mg48 $am I=
Ren6ana *iagnosti#:
"eri#sa ele#trolit
Foto thora
1727015
13.00
"ulmonologi
S:
Sesa# ti*a# a*a atu# ti*a#
a*a *emam ti*a# a*a ri%a-at
AT ti*a# a*a ri%a-at
mero#o# ti*a# a*a ri%a-at
*iaetes a*a
:
Sa#it erat4gi;i 6u#u(4CS 15
T):1004!0HR:10
RR:304menit
Suhu:3!5
Sa:! *engan NR'
Anemis ti*a# a*a i#teri# ti*a#
a*a
=":R?1 6mH +esi#uler
*engan rhon#hi *i a(e un-i
na,as menurun *i hemithora
sinistra *an asal hemithora*etra e#stremitas:oe*em a*a
)R:
BC:11.00
H:109
T6:.000
)S:182 mg4*l
Foto thora:
/,usi (leura ilateral
A:
/,usi (leura ilateral et 6ausa
malignan6-
Tera(i:
7'eth-l(re*nisolon in$ 15
mg42 $am I=
7 10 @"' =ia NR'
Ren6ana *iagnosti#:
7Cito ,oto thora #ontrol
7Cito A)
7Ren6ana (un#si 6airan (leura7Ren6ana (emeri#saan US
7thora mar#er $i#a &U
memung#in#an
7Analisa *an sitologi 6airan
(leura
7/&
7"emeri#saan S(utum BTA 3
gram *an $amur
1727015
15.10
Be*ah *igesti,
S:
Sesa#
:
Sa0:!
Foto thora:
&esan:/,usi (leura masi,
A0. (,**+,-)
(H :.385
(C :32.2 mmHg
S :3." :25.1 mmHg
Tera(i:
7 10 @"' +ia NR'
7&onsul Cito agian e*ah
thora#s #ar*io+as#uler untu#
(emasangan 6hest tue
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HC3 :0.8 mmol4@
B/ :72.5 mmol4@
&esan :Asi*osis metaoli#
ter#om(ensasi seagian
A:
"ost " la(arotom- e#s(lorasi
e6 tumor 6olon trans+ersum
/,usi (leura
1727015
1!.30
Be*ah Thora &ar*io+as#uler
S:
Sesa# er#urang
:
&U:se*ang
RR:84menit
Saturasi 82
Un*ulasi
A:/,usi (leura ilateral (ost
(emasangan 6hest tue
Tera(i:
7"emasangan 6hest tue
7Ta#ar (ro*u#si S) tia( 2
$am
13727015
0.15
Interna
T):11840 mmHg
N:84menit
R:4menit
S:3!!0C
Sa:9!
Pe"awatan ha"i !e8
1.)' ti(e non oese
S:
@emas a*an
:
)S:11 mg4*l
./,usi (leura ilateral
S:
Sesa#
:
S:9!
Ter(asang 6hest tue ilateral
BC:11.00
@/) I:19
@/) II:52
"rotein total:53
Un*ulasi
arna 6airan (leura er%arna
#uning #e6o#latan
"ro*u#si 6airan (aru #iri:100
66"ro*u#si 6airan (aru #anan:!00
Tera(i:
)iet )' 1!00 ##al4hari
*ri( insulin 15 U4$am
Bila )SE100 mg4*l eri#an
$uga )10 500 66 2 t(m
7&ontrol )S43 $am
7Bila )S E !0 mg4*l sto( *ri(
insulin
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66
3.Hi(oaluminemia
S:
&e*ua &a#i tam(a# eng#a#
:
"itting oe*em 747
2.Hi(eruri6emia asim(tomati#
S:
N-eri sen*i ti*a# a*a
:
Tan*a in,lamasi (a*a sen*i
'T"71 ti*a# a*a
5.A&I (re renal Taha( I))4A6ute on C&)
S:
Sesa#
:
Ur:3 100
Cr:1 5
!.Anemia hi(o#rom mi#rositer
e6 *e,isiensi Fe ))46hroni6*isease
S:
@emas
:
&on$un6ti+a (u6at 747
@a:
H:109 113
'C= *an 'CH menurun
RBC:23010! U4@ 2210!
U4@
.Tumor Colon Trans+ersum
(ost o( hemi6ole6tom- *etra
S:
N-eri (a*a *aerah lu#a o(erasi
su*ah mulai er#urang
:
=AS s6ore:3410
Ter(asang stoma
"eristalti# usus
Tera(i:
7Alumin otol 0 1
otol4hari
7=I" alumin #a(sul 3
Tera(i:
7Allo(urinol ta 100 mg 11
7)iet ren*ah (urin
Tera(i:7)iet ren*ah (rotein 08
g4&gBB4hari
7)iet ren*ah garam gr4hari
7)iet ren*ah (urin
7Balan6e 6airan
7#onsul H
Tera(i:
7Atasi etiologi *asar
Tera(i *ari TS Be*ah *igesti+:
7Ce,tria#son in$ 1 gr41 $am I=
7metroni*a;ole 500 mg48 $am
I=
7#etorola6 in$48 $am I=
7alan6e 6airan
7Ra%at @u#a
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13727015
0.00
/n*o#rin 'etaoli#
S:
Ri%a-at )' (asien
mengeluh lemas ila )SE125
mg4*l
:)S:11 mg4*l
)S er#isar antara 907180
mg4*l
A:
)iaetes mellitus t-(e non
oese
Tera(i:
)iet )' 1!00 ##al4hari
*ri( insulin 15 U4$am
Bila )SE100 mg4*l eri#an
$uga )10 500 66 2 t(m7&ontrol )S43 $am
7Bila )S E !0 mg4*l sto( *ri(
insulin
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Be*ah :
CS:/3=3'5:11
&U:lemah
CS: Sa:50
T):55431 mmHg
A:
tumor 6olon trans+ersum (ost
hemi6ole6tom- *etra
Tera(i lan$ut sesuai TS anestesi
13727015
1.25
Anestesi
S:
"enurunan #esa*aran
:
CS:/1'1=1
"u(il mi*riasis total
Tera(i:
7)ila#u#an R"
7agging
7/(ine,rin 01 mg45 menit
13727015
13.10
Anestesi
"asien *in-ata#an meniggal
*unia
Peme"i!saan Penun%an#:
Peme"i!saan &olon in Loo' (*+,-):
&esan:Tumor Colon trans+ersum (roimal
5asil Labo"ato"ium (,,*+,-)
@/):
am I :19 mm4$am
am II :52 mm4$am
ST : U4@S"T :21 U4@
@)H :328 U4@
"rotein total :5.3 gr4*l
Alumin :.5 gr4*l
HA16 :9.1
H)@ :! mg4*l
@)@ :80 mg4*l
&olestrol total :1 mg4*l
Trigliseri*a :9! mg4*l
Asam urat :11 mg4*lUreum :100 mg4*l
&reatinin :.5 mg4*l
A0. (,**+,-)
(H :.385
(C :32.2 mmHg
S :3.
" :25.1 mmHg
HC3 :0.8 mmol4@
B/ :72.5 mmol4@&esan :Asi*osis metaoli# ter#om(ensasi seagian
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Kimia da"ah (,,*+,-)
Na :121 mmol4@
& :5.1 mmol4@
Cl :113 mmol4@
$oto Tho"a1 (2*+,-)
&esan:/,usi "leura Bilateral
Peme"i!saan 5emostasis (2*+,-):
CT :8
BT :3
"T :13.3
INR :1.0
A"TT :.1
Kimia da"ah (2*+,-):
)S:2 mg4*l
Peme"i!saan Imunose"olo#i (2*+,-)
HsAg :non rea#ti,
ST :3 U4@
S"T :38 U4@
Alumin :. gr4*l
)S :182 mg4*l
Ureum :3 mg4*l&reatinin :1. mg4*l
$oto Tho"a1 (,**+,-)
&esan:/,usi "leura 'asi,
.a"ah Rutin 2*+,- /*+,- ,,*+,- ,**+,-
BC 9290 890 1100 11130
RBC 2!110! 28010! 23010! 2210!
H 118 11 109 113
'C= 2! 5 !5 'CH 5! 5 53 53
Tromosit 2!000 !8000 000 98000
Neutro,il 3 89 881 80
NO
4
T#l
Peme"i!saan
9AM PEMERIKSAAN01.00 0.00 03.00 02.00 05.00 0!.00 0.00 08.00 09.00 10.00 11.00 1.00
1. 1727015 99 131 1!2 1
. 13727015 102 11 18 11813.00 12.00 15.00 1!.00 1.00 18.00 19.00 0.00 1.00 .00 3.00 2.00
1. 1727015 1!8 15 1 131 10
. 13727015 125 138 10 13
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NO
4
T#l
Peme"i!saan
9AM PEMERIKSAAN01.00 0.00 03.00 02.00 05.00 0!.00 0.00 08.00 09.00 10.00 11.00 1.00
1. 10727015 22 1!2 18! 1
. 11727015 182 128 150 1!0 1!5 195 155 1!213.00 12.00 15.00 1!.00 1.00 18.00 19.00 0.00 1.00 .00 3.00 2.00
1. 10727015 182 00 305 25 !2 5 192 0 182 189 189
. 11727015 1 12 192 180
RESUME
@a#i7la#i 50 tahun *i#onsul #e agian /n*o#rin metaoli# *ari agian e*ah *igesti, *engan
#eluhan lemas a*an -ang ti*a# *isertai #eringat *ingin -ang *ialami hari tera#hir *engan
)S:2 mg4*l *an )":18 mg4*l *ari anamnesis leih lan$ut *i#etahui ah%a (asien memili#i
ri%a-at )' -ang su*ah *i*erita (asien se$a# tahun 003 meng#onsumsi glien#lami* namun
*i#onsumsi se6ara ti*a# teratur oleh (asien. "asien masu# rumah sa#it (a*a tanggal 8727015 *engan
ru$u#an *ari RSU) Bau7Bau *engan #eluhan sulit BAB *an (erut *irasa#an tam(a# memesar se$a#
minggu seelum masu# rumah sa#it mual *an muntah a*a. )ari hasil (emeri#saan Ra*iologi *i
RSU) Bau7Bau *i#ata#an (asien men*erita #an#er usus (asien telah men$alani o(erasi *i RSUH
(a*a tanggal 9727015. "asien $uga mengeluh atu# -ang ersi,at hilang timul *isertai *aha# -ang
er%arna $ernih *an #ental -ang su*ah erlangsung se$a# tahun tera#hir *isertai (enurunan erat
a*an *rastis se$a# ulan tera#hir *imana (asien turun 8 #g *alam ulan (asien memili#i ri%a-at
#eiasaan mero#o# se$a# usia mu*a *an rata7rata meng#onsumsi 17 ung#us4hari.
"a*a (emeri#saan ,isi# *i*a(at#an (asien tam(a# sa#it se*ang #esa*aran 6om(os mentis
CS 15
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/,usi (leura a*alah suatu #ea*aan *imana ter$a*i (enum(u#an 6airan meleihi normal *i
*alam 6a+um (leura *iantara (leura (arietalis *an +is6eralis *a(at eru(a transu*at atau e#su*at.
"en-a#i7(en-a#it -ang *a(at menimul#an e,usi (leura a*alah tuer#ulosis in,e#si (aru non
tuer#ulosis #eganasan sirosis hati trauma in,ar# (aru serta gagal $antung #ongesti,. Ter*a(at
eera(a teori tentang timuln-a e,usi (leura (a*a neo(lasma -a#ni:menum(u#n-a sel7sel tumor
a#an mening#at#an (ermeailitas (leura terha*a( air *an (rotein a*an-a massa tumor menga#iat#an
tersumatn-a aliran (emuluh *arah +ena *an getah ening sehingga rongga (leura gagal *alam
memin*ah#an 6airan *an (rotein *an a*an-a massa tumor memuat in,e#si leih mu*ah ter$a*i *an
selan$utn-a timul hi(o(roteinemia. e,usi (leura *a(at $uga ter$a*i (a*a #ea*aan hi(oaluminemia
*imana e,usi ter$a*i #arena ren*ahn-a te#anan osmoti# (rotein 6airan (elura *ian*ing#an *engan
te#anan osmoti# *arah1 *imana (a*a (asien #ami men*uga -ang men$a*i (en-ea *ari e,usi (leura
(a*a (asien a*alah #arena #eganasan -ang ermetastasis #e (aru *an a*an-a
#on*isi hi(oaluminemia.(a*a (emeri#saan ,isi# (aru *itemu#an ta#til ,remitus *an +o#al ,remitus
-ang menurun serta suara na,as -ang melemah sam(ai menghilang (a*a agian (aru -ang mengalami
e,usi *an tra#ea -ang ter*orong #e #ontralateral.1 "a*a (emeri#saan ,isi# (aru -ang *ila#u#an (a*a
(asien *i*a(at#an (a*a ins(e#si (ergera#an rongga thora#s asimetris *imana (ergera#an (aru #iritertinggal (a*a (al(asi *i*a(at#an ta#til ,remitus -ang menurun (a*a (aru #iri setinggi ICS = *an
(aru #anan menurun setinggi ICS =I (a*a (er#usi *i*a(at#an (er#usi re*u( setinggi ICS = (a*a (aru
#iri *an (a*a (aru #anan setinggi ICS =I *engan suara na,as -ang melemah (a*a (aru #iri setinggi
ICS = *an (aru #anan setinggi ICS =I. Untu# #on,irmasi *ugaan a#an a*an-a e,usi (leura ma#a
mutla# *i(erlu#an (emeri#saan ,oto thora#s
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seai#n-a "enari#an 6airan (a*a thora6o6entesis seai#n-a ti*a# meleihi 1 liter *imana (enari#an
6airan D 1715 liter *a(at men-ea#an ter$a*in-a re7e(ansion (ulmonar- oe*em. 3 &ami (i#ir#an
ter$a*i re7e(ansion (ulmonar- e*ema (a*a (asien #arena a*an-a ge$ala sesa# (a*a (asien -ang
*irasa#an tia7tia *an mun6ul *alam 2 $am *an a*an-a tan*a hi(o#semia *engan saturasi o#sigen
50 setelah *ila#u#an tin*a#an thora6entesis *engan (enari#an 6airan (a*a (aru #iri 100 66 *an
(a*a (aru #anan seesar !00 66. (enanganan umumn-a eru(a (enanganan su(orti, *engan
(emerian o#sigen *engan nonin+asi+e +entilation *an in+asi+e +entilation.2"a*a (asien *ila#u#an
(emasangan intuasi en*otra#eal untu# mengo(timal#an (emerian o#sigen.
)i(i#ir#an $uga #emung#inan lain -aitu ter$a*in-a mediastinal shift a#iat (engemangan
(aru -ang terlalu 6e(at sehingga ter$a*i (ene#anan (a*a aorta $antung *an (emuluh *arah esar
*alam ruang me*iastinum sehingga te$a*i (enurunan aliran *arah ali# *an ter$a*i (enurunan cardiac
output *ii#uti *engan ter$a*in-a (enurunan te#anan *arah -ang men-ea#an ter$a*in-a s-o#
#ar*iogeni#.8
/moli (aru meru(a#an #ea*aan ter$a*in-a ostru#si seagian atau total sir#ulasi arteri
(ulmonalis atau 6aang76aang a#iat tersang#utn-a emoli tromus atau emoli -ang lain. Fa#tor
(re*is(osisi ter$a*in-a emoli (aru menurut =ir6ho% 185! meli(uti 1>. A*an-a aliran *arah -ang
lamat >. &erusa#an *in*ing (emuluh *arah +ena *an 3>. &ea*aan *arah mu*ah meme#u
. Aliran *arah -ang lamat *a(at *itemu#an (a*a eera(a #ea*aan misaln-a
(a*a imoilitas tirah aring anestesi *an gagal $antung #ongesti,. )arah -ang mengalir lamat
memeri #esem(atan leih an-a# untu# meme#u . &erusa#an *in*ing (emuluh *arah
+ena *a(at ter$a*i (a*a #ea*aan misaln-a (a*a trauma *an (eme*ahan *imana #erusa#an en*otel
(emuluh +ena *a(at men-ea#an a#ti+asi (roses (eme#uan. &ea*aan *arah mu*ah meme#u $uga
meru(a#an ,a#tor (re*is(osisi ter$a*in-a tromus misaln-a (a*a #eganasan tromositosis essensial
*an (olisitemia +era."a*a (asien #ami memi#ir#an #emung#inan $uga ter$a*in-a emoli (aru #arena
a*an-a ,a#tor (re*is(osisi (a*a (asien -aitu a*an-a ri%a-at #eganasan (a*a (asien a*an-a ri%a-at(eme*ahan *an tirah aring serta immoilisasi (a*a (asien. &ami (i#ir#an (en-ea #ematian (a*a
(asien #arena ter$a*in-a re7e(ansion (ulmonar- e*ema *an #emung#inan emoli (aru -ang
men-ea#an ter$a*in-a gagal na,as sehingga men-ea#an #ematian (a*a (asien.
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Ke"an#!a Konse':
DM Ca Colon
Transversu
Pembedahan
(kerusakan
Trombos
Resiko trombosis
meningkat
Tirah
baring
Hipoalbumine
Keganasan
(hiperkoagulab
Kematia
Gagal
a!as
Thora"o"en
tesis
#!usi
Pleura
$munit
as
T%&&
Mediastin
al Shift
Reexpansionpulmonary
oedem
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.A$TAR PUSTAKA
1. Halim Ha*i. "en-a#it7(en-a#it "leura. )alam: Bu#u A$ar Ilmu "en-a#it )alam Su*o-o A
et al. /*isi =I ili* II. a#arta: "usat "eneritan I") F&UIG hal. 1!3171!39.. Rahmatullah "asi-an. Tromoemoli "aru. )alam: Bu#u A$ar Ilmu "en-a#it )alam Su*o-o
A et al. /*isi =I ili* II. a#arta: "usat "eneritan I") F&UIG hal. 1!9071!99.
3. Fau6i Anthon- S et al. Cha(ter 2: "ro6e*ures Commonl- "er,orme* - Internists
in:HarrisonJs "rin6i(le o, Internal 'e*i6ine 18th/*ition. USA:'6 ra%7Hill 013 3073.
2. Rahil &asmani ') Far;an I ') et al. Re7e(ansion (ulmonar- e*ema ,ollo%ing
thora6entesis. Cana*ian 'e*i6al Asso6iation ournal. No 18 . 010
5. Rasha AlKa*i ') Carolina F =alen6ia ') et al. Re7e(ansion (ulmonar- e*ema ,ollo%ing
thora6entesis. Rho*e Islan* 'e*i6al ournal. 013
!. /*uar*o HenriKue eno,re Fransis6o S =argas et al. Re7e(ansion (ulmonar- e*ema.
"neumol 003G 9:1017!.
. A(arna A#ella Shri(a* B )esh(an*e. "ulmonar- Sur,a6tants an* their role in
(atho(h-siolog- o, lung *isor*ers. In*ian ournal o, /(erimental Biolog- =ol. 51 anuar-
013 ((. 57
8. Hanle- 'i6hael / Carol-n H. elsh. Current Diagnosis & Treatment in Pulmonary
Medicine1ste*ition. '6ra%7Hill Coma(nies.USA:003. /7oo#
#mboli
S'ok
Kardiogeni