koran digestif senin 26 november 2012

KORAN BEDAH DIGESTIF SENIN, 26 November 2012

LONTARA II ATAS DEPAN (BEDAH DIGESTIF) KAMAR 1№ IDENTITAS DIAGNOSIS PEMERIKSAAN PENUNJANG Keterangan/PJ1. Ny. Wiwik P/26

thn/409405 MRS 17/11/12

K1 Bed 1

Tu Abdomen Suspek Kista Lien

Lab 22/11/2012GDS 85, ur/cr 22/0,9 GOT/GPT 17/16 Na 138 K 4,1 Cl 107 HbsAg(-) WBC 8,56 RBC 4,68 Hb 13,9 Hct 40, 4 PLT 241 CEA 0,91 BT 8 AFT 67 Protein total 7 Alb 4,2 LDH 342USG Abdomen 17/11/12Massa Hipokondrium kiri ekstraluminar susp. Tu. MesenteriumEchocardiography 17/11/12Normal echocardiographyFoto Thorax 17/11/12Tidak ditemukan kelainan pada foto thorax ini.MSCT Urografi dengan kontras 17/11/12Hydatid Cyst Spleen

Rencana operasi hari

selasa(26/11/2

2. MegawatiP/20 thn57’6291MRS 31/11/12K 1 Bed 2

Riwayat BAB campurdarahsejaksekitar 8 bulanlalu, kadangdarahsegarataudarahkehitamanbergumpal. Rwytpenurunanberatbadansekitar 30kg sejak 8 bulan

D/Ca Recti 1/3 Distal

Lab 25/11/12Na/K/Cl 142/3,02/108Thorax 24/11/12Tidak tampak kelainan pada foto thorax iniMSCT upper abdomen 21/11/2012Sesuai dengan gambaran kista heparPA 20/11/2012Bekuan darah dan sedikit kelenjar tanpa malignitasLab 21/11/2012GDS 91 ur/cr 19/0,5 GOT/GPT 17/8,3 Albumin 3,3 Na 135 K 2,9 Cl 103CT 7’00’ BT 3’00’ PT o,88 aPTT 26,1-26,1RBC 4,78 WBC 8,68 HB 12,2 HcT 35,9 PLT 527 Lab 09/11/12 Ur/Cr 18/0,6 SGOT/SGPT 17/7 Prot tot. 6,0, Alb 2,9, Globulin 3,1Lab 09/11/12 CEA 37,88Lab 08/11/12 WBC 11,3 RBC 4,29 Hb 11,0 HCT 33,1 PLT 576GDS 131 Ur/Cr 14/0,6 SGOT/SGPT 14/7 Prot tot. 6,4 Alb 3,5 Ct 8’00” BT 2’00” Na/K/Cl 136/2,6/103 HBsAg (-) Anti HCV (-) PT 11,4 INR 0,95 APTT 22,8USG ABDOMEN 31/10/2012Kesan: suspmassarectum,hidronefrosise.chidroureter bilateral CT-Scan abdomen

- Tu. Rectosigmoid (DUCKES C)- Pelvoectasis (D) danhidronefroureter (S)

Colon InLoop (13/11/12)- CaRektitipeskirrus 1/3 distal

Rencana operasi senin (25/11/2012)Konsul perianestesisenin (19-11-12)

Konsul urologi (15-11-12)

3. FitrianiP/ 23 thn/RM 577081

bed 3

Abses illiopsoas Lab 25/11/2012GDS 95 ur/cr 13/0,5 GOT/GPT 23/16 Alb 3,9 Na/K/Cl 138/4,1/101 WBC: 10,98RBC=4,81 PLT=525 HGB=12 HCT=36,9Lab 18/11/2012WBC 8,83 RBC 4,78 Hb 12 Hct 37,2 PLT 544 CT 8 BTY 2 PT 1,1 aPTT 23 kontrol 26,7 GDS 109 ur/cr 10/0,9 GOT/GPT 23/16 Alb 4,1Lab 8/11/2012WBC 15,45 RBC 4,09 HB 12,2 HCT 37,6 PLT 334 CT 7’00” BT 2’00”PT 10,5 control 11,6 aPTT 27,4control 27,9 ur/cr 8/0,6GOT/GPT 14/12 Albumin 3,1 HbsAg (-)Lab 5/11/2012WBC 10,02RBC 5,51HB 13,5 HCT 43,5 PLT 451 CT 8’oo” BT3’00” PT11,0 control 11,1 aPTT 25,7 control 30,0 GDS 101 ur/cr 12/0,5 GOT/GPT 33/22

4 Hatijah/P/69/ 578479/ MRS 12/11/2012

bed 4

d/ Tu Abdomen susp. Abses Hepar

CT ScanSesuai gambaran kista heparHasil Lab 23/11/12Na/K/Cl= 136/4,45/107AFP=1,43 WBC=10,4 RBC=2,5 HGB=5,2 HCT=17,8 PLT = 291Lab 19/11/2012WBC 7,54 RBC 4,69 HB 10,3 HCT 33,1 PLT 264 Ur 36 Cr 0,3 GOT 43 GPT 24 P tot 6,4 Alb 2,8 HbsAg: Positif

1


CT Abdomen tanpa kontras 13/11/2012Kista Hepar

LONTARA II DIGESTIF ISOLASI5. Hanafiah

Tarra/P/37/580097/ MRS 23/11/2012/ bed 2

d/ POH 3 Laparotomi e.c. Apendisitis Perforasi

Lab 23/11/2012WBC 20,71 RBC 4,35 HCT 38,3 HB 12,6 PLT 291 CT 7’00” BT 2’30” PT 13,4 control 10,9 APTT 22,9 control 26,1 GDS 110 Ur 28 Cr 0,7 SGOT 19 SGPT 15 PTot 6,4 Alb 3,5 Na 142 K 3,9 Cl 107 HBsAg (-) Anti HCV (-)

UGD Abdomen 23/11/2012Tidak tampak kelaianan radiologic pada USG abdomen ini.

6 Hasniati/p/56 tahun/bed1/580333/MRS 25/11/2012

Tumor abdomen Lab 25/11/2012GDS 115 Ur/cr 20/0,6 Bil. Tot 1,1 Bil. Direk 0,4 GOT/GPT 34/8 Prot.total 5,4 Albumin 3,2 WBC 11,6 RBC 3,98 HGB 10,0 HCT 33,1 MCV 83,2 MCH 25,1 PLT 347Hasil PA 26/7/2011Leiomyosarkoma grade I

LONTARA II ATAS DEPAN (BEDAH DIGESTIF) KAMAR 26 Ahmad Saini

L/52th572422MRS 08/11/2012JKMK2 bed 1

Benjolan perut kiri sejak 3 bulan lalu

D/ Tu.ColonsigmoidPOH 5 hemikolektomi sinistra

Post pemasangan CVC

Lab 21/11/12WBC 4,40 RBC 4,15 HB 11,3 HCT 34,3 PLT 233Lab 17/11/12NA 135 K 3,9 Cl 104Lab (09/11/2012)WBC 12,72 RBC 4,32 HGB 11,1 HCT 34,2 PLT 334 GDS 116 Ur/Cr 23/0,6 GOT/GPT 47/17 CT/BT 7’00”/2’00” PT/APTT 11,5/22,7 Bil.total 0,5 Bil.direct 0,2 Na/K/Cl 127/2,8/9,3 Alkali fosfatase 325 Protein total 6,7 Alb 2,8 Globulin 3,9 As.urat 7,6 CEA 12,57Spirometri (08/11/2012)Kesan : restriktif, resikoringanuntukpembedahan abdomenColon in loop (07/11/2012)Sesuaigambaran tumor colon descendensFoto thorax (07/11/2012)Pulmo normal, atherosclerosis aorta, tidaktampaktanda-tanda metastasis padafoto thorax iniUSG Abd (07/11/2012)Tu.colondescendensdisertai metastasis keheparEchocardiography 9/10/2012 :Kesan : disfungsi diastolic, Fungsisistolik LV dan RV baik EF 70, LVH (+)Pemeriksaan LGIE 15/10/2012 :Kesan : Tumor kolon sigmoid susp.malignancyPA (15/10/2012)Adenocarcinoma, differensiasisedangCT-Scan abd (05/10/2012)Kesan : Massa kolondescendens, multiple abseshepar

7 NasrunL/60 thn 576164MRS 30/10/12 Bed 2

Inkontinensia urin post op ca recti

Foto BNOCa RectosigmoidLab 20/11/12 WBC 16,09 RBC 4,35 Hb 11,4 HCT 36,2 PLT 319 Alb 2,8Lab 11/11/12 WBC 12,91 RBC 4,3 Hb 11,4 HCT 35,5 PLT 338CT/BT 6’30” PT/APTT 13,2/23.2 Ur/Cr 26/1,3 SGOT/SGPT 14/12 Bil.Tot 0,13 BilDirek 0,09 Prot tot. 5,3 Alb 1,6 Na/K/Cl 139/3,5/107Lab 03/11/2012 :WBC 381,94 RBC 1,70 Hb 5,8 HCT 15,9 PLT 322Lab 02/11/2012 :HbsAg (-) Anti HCV (-) kolesterol total 141, kolesterol LDL 77, Na 132, Kalium 3,2 Cl 103PA 12/10/2012 :Adenocarcinoma colon moderately differentiated yang sudahmetastasekekelenjarlimfeCT scan abdomen 31/10/2012

- Massa rectum yang menginflitrasibulibuli- Hydronefrosisdanhydroureter bilateral

Lab 30/10/2012 :GDS 102, Ur/Cr 25/0,9 GOT/GPT 14/17 Na 138, K 3,1, Cl 105, WBC 15,29, RBC 2,56 Hb 5,8 HCT 19,8 PLT 475

2


8 LadamingL/55thn577950MRS 14/11/12

D/ tu.abdomen susp kista pancreas

Lab 24/11/12WBC 6,3 RBC 4,10 HB 9,8 HCT 33,9 PLT 315 CT:7’00 BT:2’00 ur/cr 19/0,6 GOT/GPT 26/8 Alb 2,5 Na 142 K 4,16 Cl 109

Lab 14/11/12WBC 5,7 RBC 4,27 HB 10,5 HCT 33,9 PLT 454 ur/cr 31/0,6 GOT/GPT 26/8 Alb 2,5 Na 142 K 4,16 Cl 109CT Abdomen 09/11/12Kesan : suspkista pancreas dd/kistamesenterikaAsitesdanefusi pleura bilateralLab 14/11/12WBC 5,99 RBC 3,74 HGB 85 HCT 29 PLT 607CT/BT 7/2 PT/APTT 14,5/27,5 NA/K/Cl 141/4,09/104 HBsAG NEGATIF ANTI HCV NEGATIFGDS 85 UR/CR 18/0,7 GOT/GPT 7/9 PROTEIN TOTAL 6,6 ALBUMIN 2,6

Rencana operasi hari

29/11/12

9 Tn. NyambangL/36thn481521MRS 07/11/2012

Bed 4

Tumor colon ascendens

Lab 22/11/12WBC 7,22 RBC 4,51 HB 10,5 HCT 33,9 PLT 608 GDS 124 ur/cr 21/0,7 GOT/GPT 11/4 Alb 2,3 CT/BT 7’00”/3’00” PT/APTT 10,9/26,9 Na 133 K 3,3 Cl 115 Colon – in loop (19/11/12)Sesuai gambaran tumor colon ascendensTanda-tanda ileus obstruktifLab (12/11/12)CEA 3,15 WBC 10,56 RBC 5,02 HGB 11,7 PLT 208 Na/K/Cl 136/3,9/115 GDS 46,Ur/Cr 19/0,7 GOT/GPT 20/11 Alb 2,5Lab (08/11/2012)WBC 7,59 RBC 4,29 HGB 9,5 HCT 31,3 PLT 487Lab (07/11/2012)WBC 9,75 RBC 4,10 HGB 8,8 HCT 29,9 PLT 545 CT/BT 7’00”/2’00” PT/APTT 11,1/25,0 HBsAg(-) AntiHCV(-)CT-Scan Abdomen (19/10/2012)- Dilatasi loop-loop usus ec massa intraluminer colon ascendens- Batu pada GB dan CBD

LONTARA II ATAS DEPAN (BEDAH DIGESTIF) KAMAR 310 Sardin

L/38 thn576860MRS 3/11/12

Bed 1

-POH 7 hemikolektomi dextra

LAB 24/11/12WBC 13,72 RBC 3,24 HB 9.0 HCT 28,1 PLT 328 CT/BT 8’/3’ PT/APTT 13.3/32,6 INR 1.09 GDS 92 UR/CR 4/0.5 GOT/GPT 19/7 PROT.TOT 4,6 ALBUMIN 2,1 NA 141 K 2,7 CL 106Lab 19/11/2012WBC 10.76; RBC 3.93;HB 10,9;HCT 33,5;PLT 275USG Abdomen (09/11/2012)Kesan : Tidak tampak kelainan pada USG abdomen saat iniLab 0 3 /11/2012 WBC 10,99, RBC 4,34, Hb 11,9, HCT 36,9, PLT 413CT 7’00”, BT 2’30”, PT 12,8, APTT 28,0GDS 136, Ur 16, Cr 0,9, Bil total 0,35, Bildirek 0,06 GOT 20, GPT 10Protein total 7,7, Alb 3,2, Na 143, K 4,09, Cl 105LED 102/119

11 Tn. SaparuddinL/53thn580051Bed 2MRS 22/11/12

d/ cholesistitis + cholelithiasis

LAB 24/11/12WBC 5,83 RBC 5,87 HB 15,1 HCT 45,4 PLT 236 CT/BT 7’/2’.30” PT/APTT 10,2/29,3 INR 0,9 GDS 66 BIL.TOT 1,3 BIL DIREK 0,3 PROT TOT 7,6 ALB 4,2 GLOB 3,4 KOL.TOT 134 HDL 32 LDL 88 TRIGLISERIDA 69 AS.URAT 5,8 NA 146 K 35 CL 107 HBS-AG (-) ANTI-HCV (-)Lab 22/11/12GDS 121, Ur/Ctr: 9/1,0 GOT/GPT: 18/8USG abdomen 23/11/12Kesan: cholelith

12 HalidiL/44thn/577619/JKM/MRS 7/11/2012

Tu. Abdomen susp. CaRekti 1/3 DistalTu. ascenden

Post pemasangan

Lab 21/11/2012WBC 13,73;RBC 3,17; HB 8,2; HCT 23,7; PLT 273Ur/Cr 134/7,3; Na 134; K 5,0; CL 106PA 21/11/12Metastasis suatu adenocarsinoma pada umbilicus

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Bed 3 CVC Lab (15/11/2012)WBC 13.94 RBC 3,23 HGB 8,3 HCT 24,6 PLT 346GDS 80 Ur/Cr 137/12,0 Na/K/Cl 148/4,8/112Lab. 113/11/2012CEA 1360, albumin 3,0Lab 07/11/2012CT 8’00 BT 2’00 PT 15,2 APTT 39,2 GDS 105 Ur/Cr 191/15,1 Protein Total 6,0 Alb 3,1 GOT/GPT 16/13 Alb. 2,5 Bil.Total 0,65 Bil.Direct 0,36Na 143 K 5,4 Cl 107 HbsAg – Anti HCV – Lab 07/11/2012USG ABDOMEN :Kesan : - Massa ekstraluminalsusp. Massa mesenterium

- Pelviocaliectasis bilateral- Asites et efusi pleura bilateral

Lab 08/11/2012 WBC 14,22 RBC 3,96 Hb 10,4 PLT 465Lab 08/11/2012AGD: pH 7,41 pO2 84,7 pCO2 27,9 SO2 95,4 HCO3 17,3 ctO2 15,7 ctCO2 13,7 BE 6,1

13 Suprianto Djapar/ 30 thn/ L/ 579123/MR: 17/11/12 Askes wajibBed 4

Abses hepar

PH 9

Lab 25/11/2012WBC 12,58 RBC 4,69 HGB 12,2 HCT 39 PLT 607 GDS 139 Ur/Cr 23/0,7 GOT/GPT 22/20 Albumin 3,4 Na 140 K 4,8 Klorida 100Lab (22/11/12)GDS 125 AFP 1,41 CT/BT 8’/3’ PT/ APTT 13,9/24,1Thorax AP (18/11/2012)Elevasi diafragma DCT Scan Abdomen (18/11/12)Abses hepar dengan perluasan ke dinding abdomenUSG Abdomen (18/11/12)Suspek absespada hipokondrium kananLab (18/11/12)WBC:18,84 RBC:4,91 Hb:13,2 HCT:39,8 PLT: 396Na:140 K:4,37 Cl: 104 HBsAg: (-) antiHCV: (-) globulin (4,8) albumin:3,4GDS:132 Ur/Kr: 22/0,6 Bil.Total:1,52 B.direk:0,9 GOT/GPT:48/75 prot.Tot: 8,2 PT/aPTT:15,4/25,

LONTARA II ATAS DEPAN (BEDAH DIGESTIF) KAMAR 1014 Ny. Rukya

MRS 21/11/201259 thn/ P579801BED 1

D/ POH 6 appendectomi akut

Lab 23/11/12WBC 9,97 RBC 3,81 HB 9,6 HT 30,5 PLT 278Lab 21/11/12WBC 17,8 RBC 4,51 HGB 11,8 HCT 36,6 PLT 345 CT/BT 8/4 PT/APTT : 14,3/ 24,1 GDS 122 UR/CR:21/0,6 GOT/GPT 42/15 Na 137 K 4,2 Cl 102 anti HCV (-) USG abdomen 21/11/12 Appendicitis akut

15 MaemunnahP/59 thn575178MRS 22/10/12UmumBED 2

POH 31 Herniolaparotomiec HIL (D)

Lab 21/11/2012WBC:6,39; RBC:3,57; HGB:10,2; PLT:436; prot.tot:4,6; alb:2,7; Na:136; K:3,5; Cl:106; GOT/GPT 15/8 Ur/cr 17/0,3 Lab 13/11/2012Wbc 6,93 rbc 3,78 HGB 10,7 PLT 494 GDS 112 Prot. Total 4,6 Alb 2,6 Na 146 K 3,3 Cl 107L ab 27 /10/2012 : WBC 11,13 RBC 4,25 Hb 12,4 Hct 35,6 PLT 331 GDS 62 Ur 23 Cr 0,4 GOT 13 GPT 15 Prot. Total 5,0 Alb 2,7 na 138 K 2,5 Cl 106Lab 25/10/2012 : WBC 5,69 RBC 4,46 Hb 12,8 HCT 37,8 PLT 297 Alb 3,0 Na 138 K 2,7 Cl 102USG Ginekologi 26/10/2012 : Hernia inguinal DextraLab 22/10/12 WBC 14,92 RBC 4,78 Hb 9,3 HCT 41,2 PLT 363 CT 8’00 BT 3’00 PT 11,3 APTT 23,5 INR 0,5 GDS 109 Ur 47 Cr 0,5 GOT 21 GPT 15 Albumin 3,6 Na 140 K 3,9 Cl 102 HbsAg negatif anti HCV negatifFoto thorax AP 22/10/12 Kesanpulmo normal, cardiomegaly dengan dilatation et elongation aortaFoto BNO 3 Posisi 22/10/12:Kesan: sesuaigambaran small bowel obstruksi

16 InadiaP/30 tahun579356MRS 19/11/2012

Tumor gaster Lab 25 /11/12 WBC 6,57 RBC 2,14 HB 5,8 PLT 247 GDS 145 GOT/GPT 25/12 Albumin 2,4 HbsAg (-) CT/BT 7’00”/2’00” PT/APTT 11,5/26,4 Ur/Cr :35/0,5

4


Bed 3 USG abdomen 22/11/12Massa hipokondrium kiri suspek massa intraluminen colon flexura lienalis- colon desendensAcites dan efusi pleura kiri CT scan abdomen lower tanpa kontras 21/11/12 Kesan: tumor gaster Atelektasis paru kiri+efusi pleura kiriFoto thoraks 19/11/12Efusi pleura sinistraCardiomegali Lab 1 9 /11/12 WBC 10,16 RBC 4,17 HB 11,7 PLT 561 GDS 106 GOT/GPT 19/11 Albumin 3,0 HbsAg (-) CT/BT 7’00”/2’00” PT/APTT 11,5/26,4

17 Ny Siang17/10/201256 thn/p579439JKM‘Bed 4

POH 12 laparotomi hemi kolektomi D ec Tumor cecum 1/3 poximal colon transversum

Lab 22/11/12WBC 10,32 RBC 3,64 HB 10,3 PLT 436 widal salmonella typhi o 1/320Lab 18/11/2012WBC 23,88; RBC 3,62;HB 10,2; HCT 31,5; PLT 397; GDS 93; Ur/Cr 7/0,2; SGOT/SGPT 18/13;Alb 2,4; Globulin 2,3; CT 8’00” ;BT 2’00”; Na 136; K 3,0; Cl 101Lab 05/11/2012hbsAg(+) CEA10,93LGIE 25/10/2012Kesan:tumor colon ascenden supek malignansiT scan abdomen 18/10/2012Kesan: Massa lama luminer colon ascendensHepatomegaly dgn Fatty liverSplenomegalyEfusi pleura bilaterlUSG abdomen 17/10/2012Kesan: massa lama luminer suspek tumor ascendens dan rtransversum disertai lymphadenopathy pars aorta abdominalAscites

18 Ny. CayaP/47tahunMRS 20/11/12569811jamkesmasbed 6

Tumor anorectal LAB 21/11/12WBC 11,7 RBC 4,96 HB 9,4 HCT 31,6 PLT 5,99 GDS 127 UR/CR 29/0,7 SGOT/SGPT 13/17 HBSAG (-) ANTI-HCV (-) PT/APTT 10,2/23,8 CT/BT 7’/2’ NA 136 K 4,2 CL 105Lab 20/11/12WBC 8,5 RBC 4,10 HB 7,8 PLT 398 GDS 130 UR/CR 41/0,7 GOT/GPT 9/8 prot.total 5,3 albumin 2,3 globulin 3,0 Na 140 K 3,8 Cl 108 Anti HCV (-)USG abdomen 22/11/12Kesan: akumulasi cairan bebas di cavum douglassiFoto thorax 21/9/12Tidak tampak tanda-tanda metastaseMSCT virtual colonoscopy non kontras Kesan: massa rectum

LONTARA II ATAS DEPAN (BEDAH DIGESTIF) KAMAR 1119 Mahmud

L/57tahun578819MRS 14/11/2012K4 Bed 1

HIL D/S Residif Lab 22/11/2012GDS 107 Ur/cr 42/2,0 GOT/ GPT 14/9 alb 4,0 Na 143 k 5,02 Cl 108 CT 7 BT 2 Pt 12,7 aPTT 28,8 HbsAg (-) WBC 56,54 RBC 5,52 Hb 11,1 HcT 36,8 PLt 1237 ADT 22/11/2012Anemia dimorfik susupek defisensi Fe D/D penyakit kronik + leukositosis tanda infeksiTrombositosis reaktifLab 14/11/2012WBC 51,57 RBC 5,73 HGB 11,3 HCT 38,0 PLT 1511 Albumin 3,8 Globulin 3,8 Na 143 K 5,5 Cl 110 HBsAg (-) Anti HCV(-) CT/BT 7’30/3’00 PT 15,3(12,3 INR 1,29 ApTT 32,1 GDS 60 Ur/Cr39/2,1GOT/GPT 24/9 Prot Total 7,6USG Abdomen 14/11/2012Kesan Splenomegaly, PNC Bilateral, Gambaran hernia inguinal dextra et sinistra

20 Sarlis/ L/ 33 thn/ 577414/ MRS 19/11/2012/ bed 2 / JKM

Tu mesenterium +Tu Femur dextra

Lab 22 /11/12 GDS 73 ur/cr 26/0,9 Got/GPT 27/43 Alkali fosfatse 111 Prot total 7,5 Alb 4,2 LDH 649 Asam urat 6,6 NA 139 K 3,9 Cl 106 HbsAg( + ) anti HCV( -) CEA 6,59 CT 8 BT 3’60” L ab 13/11/12 Bil total 0,5; bil direk 0,2; alkali fosfatase 165; protein total 6,1; Alb 3,6; Globulin 2,5;

5


LDH 6,4Lab 13/11/12AFP 0,637; CEA 6,55Lab 8/11/12WBC 6,33; RBC 4,02; HGB 12,2; HCT 35,4; PLT 344MSCT Ekstremitas Non Kontras (8/11/12)Kesan : Massa imguinal kanan susp LymphadenopathyMSCT Whole Abdomen Non Kontras (8/11/12)Kesan : Massa mesenterium susp malignancy Lab 7/11/2CT 8’00” BT 3’00” PT 12,8 control 10,7; INR 1,07; APTT 24,9 control 27,5Na 134; K 3,5; Cl 101GDS 146; Ur/Cr 52/1,0; GOT/GPT 211/36,3; asam urat 5,3HbsAg positif; anti HCV negatif

21 Sanusi Dg RowaL/ 56 thn575223MRS 2/11//12BED 3JKM

POH XIV laparotomi eksplorasi removal tumor anastomose jejunojejunostomi

Lab 25/11/2012WBC 8,74 RBC 3,13 Hb 8,8 HCT 28,3 PLT 805 Lab 21/11/2012GDS 125 Ur 25 Cr 0,5 Sgot 24SGPT 32 Bil total 0,5 PT 11,8 APTT 22,2 Protein total 6,6 Alb 4,1 Ct 8’00” BT 2’00” AFP 1,65 CEA 1,83 alkali fosfatase 92 LDH 1492 Na 128 K 4,1 Cl 96Hasil PA 20/11/2012Moderate Grade SarcomaLab 16/11/2012Alb 2.5 GDS 90 Ur/Cr 34/0,8 GOT/GPT 52/46 WBC 12.77 RBC 3.38 HGB 9.8 HCT 29,8 PLt 252Lab 15/11/2012WBC 13,56 RBC 2,78 HGB 7,9 HCT 24,8 PLT 236Lab 14/11/2012GDS 80 Ur/Cr 43/0,8 WBC 16,96 RBC 3,01 HGB 8,7 HCT 27,0 PLT 221Lab 13 /11/2012 WBC15,92 RBC 3,64Hb 10,6 HCT 31,3 PLT 163 GDS 178 Ur 37PT 11,7 APTT 28,2 Lab 05/11/2012WBC 6,92 RBC 4,10 Hb 12,5 HCT 37,7 PLT 198 GDS 102 Ur 25 Cr 1,1 Sgot 39SGPT 22 Bil total 0,5 PT 11,8 APTT 22,2 Protein total 6,6 Alb 4,1 Ct 8’00” BT 2’00” AFP 1,65 CEA 1,83 alkali fosfatase 92 LDH 1492 Na 136 K 3,8 Cl 105Lab 23/10/2012WBC 7,6 RBC 4,17 HB 12,9 HCT 37,9 PLT 262, GDS 74, Ur 26 Cr 1,2 SGOT 52 SGPT 29albumin 4,1CT 7’00” BT 3’00” PT 10,2 APTT 24,1 Na 139 K 4,7 Cl 102 HbsAg (-). Anti-HCV (-).FotoThoraks 23/10/12Kesan: Dilatatio aortaTidaktampak metastasis padafotothoraksiniP atologiAnatomi 29/10/12 Malignant Epithelial TumorCT Abdomen 1/11/12Kesan: Massa MesenteriumdenganlympadenopathyparaaortaEcho 2/11/12Kesan: Fungsisistolik LV baik, EF 75%MR Trivial, PR Mild, Disfungsidiastolik

22 YanLegiL/46thn568491MRS 16/09/12Bed 4JKM

POH 47 debulking tumor + colostomy double barrel ec. SCC anorectal

Lab 17/11/2012Na 124; K 3,4; Cl 109; WBC 10,19; RBC 3,82; HB 11,1; HCT 33,5; PLT 160Lab 16/11/2012WBC 7,16 RBC 4,11 HGb 12 HCT 37,5 PLT 366 GDS 119 Ur/Cr 17/0,6 GOT/GPT 19/11 albumin 3,1 Asam urat 8,9 Na 140 K 4,4 Cl 109Lab 05/11/2012WBC 6,37 RBC 3,87 Hb 11,3 HCT 34,5 PLT 304 Protein total 6,1 Alb 2,4Lab 17/10/2012 : WBC 10,19 RBC 3,82 HGB 11,1 HCT 33,5 PLT 160 Protein Total: 5,0 Albumin 1,9 Globulin 3,1 Na/K/Cl 124/3,8/109Hasil PA 11/10/2012Kesimpulan: Adenokarsinoma recti differensiasi sedangLab 09/10/12WBC 18,32 RBC 2,45 HGB 6,8 HCT 21,3 PLT 201Lab 07/10/12WBC 8,50 RBC 2,16 HGB 6,0 HCT 18,5 PLT 214 PT 11,9 ctrl 12,5; INR 1,0 APTT 28,6 ctrl 28,1 Na 132 K 3,79 Cl 103Lab 02/10/12: WBC 12,35 RBC 2,14 hb 6,2 HCT 18,2 PLT 257 CT 7’ BT 3’ PT 13,7 ctrl

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11,9 APTT 19,8 ctrl 27,4 GDS 99 Ur 23 Cr 1,1 SGOT 24 SGPT 14 Na 138 K 4,4 Cl 107Lab 25/9/12: Na/K/Cl: 131/3,9/110 CT/BT 8’00/3’00 PT 13,6 APTT 39 GDS 102 Ur/cr: 49/1,0 GOT/GPT 34/16 ALB 1,7 Ca 5,2 Mg 2,1PA 25/09/12: Squamos cell carcinoma non keratinizing differensiasi sedang + peradangan supuratifLab 22/09/12: GDS 100 Ur/Cr 31/0,9 GOT 26 GPT 8 Alb 2,3 Na 122 kalium 108 WBC 21,43 RBC 3,03 HGB 7,9 HCT 25,4 PLT 169CT Abdomen 20/09/12: Massa rectum dengan limfadenopathy inguinal bilateral + efusi pleura bilateralLab 18/09/12:WBC 14,05 RBC 4,35 HGB 11,3 PLT 329Lab 13/09/12 : CT/BT 8’20 PT?APTT 13,2/444,7 GDS 125 Na 36 K 3,7 Cl 105 Alb 2,2CXR 13/09/12 : Pulmo normal, dilatatio aortae, tidak tampak metastasis pada foto radiologi iniEcho (17/9/12)-disfungsi diastolik-fungsi sistol LV dan RV baik, EF 68%, -LVH (+), -AR trivial

23 JufriL/ 49 thun392311MRS 16/11/2012Bed 6

Ileus obstruktif parsial

Lab 22 /11/2012 CEA 1,69 Lab 18/11/12WBC 7,18 RBC 3,57 HB 7,5 HCT 24,7 PLT 449 GDS 146 Ur/cr 81/1,8 albumin 2,4 Na 141 K 3,5 Cl 111 Abd pls 3 posisi Kesan : Gambaran ileus obstruksiSusp nephrolith dextraIVUUSG abdomen 17/11/2012Kesan:PNC bilateral Hidronrfrosis D ec Nefrolith DRadiologifoto thorax 16/11/2012Kesan: Pulmo normalCardiomegalyLab 16/11/2012WBC 11,49 RBC 4,14 HB 9,4 HCT 28,1 PLT 483 GDS134 Ur/cr 95/2,4 GOT/GPT 23/13 Protein total 4,7 albumin 2,8 Na 138 k 3,6 cl 106 BT 2’00” PT 14,6 INR 1,198 aPTT 26,6HbsAg(-) Anti HCV(-)Uretrocystography 17/11/2012Kesan: stricture urethra pars posterior

PALEM ATAS24 Syamsia

P/65 thn/MRS: 20-11-12579492Askes WajibB2-9 bed 2

D/ POH 6 Laparatomi explorasi Hartman Procedure e.c Tu. Sigmoid

Lab (22/11/2012)WBC:14.37 RBC:4,58 HB:10.7 HCT:34.2 PLT:379 Na:141 K:2.8 Cl:111GDS:70 GOT/GPT:31/43 calsium: 7.2 Laktat darah: 35 CRP kuantitatif: 103Lab (21/11/2012)Gas darah: PH: 7.464 PO2: 113.9 PCO2: 32.5 S02: 98.6 HCO3: 24.0 ctO2: 15.9 ctCO2: 20.6 BE: -0.4

25 Monika P/ 41 thn/ MRSss:21/11/12B2- 1 bed 2

Cholecystolithiasis Lab (14/11/2012)WBC:7,8 RBC:4,57 HB:13,4 HCT:39,6 PLT:235 Na:139 K:4,0 Cl:109GDS:100 Ur/Kr:23/0,5 Bil.Tot:0,6 Bil.direk:0,2 GOT/GPT:22/16 CT/BT:8’00/2’00PT/aPTT:10,6/24,7 Kolest.Tot:2,6 HDL:53 TGL:98 As.urat:5,7 HBsAg: (-) antiHCV: (-)

45 Ny. HariatiP/49thn579589MRS 20/11/12ASKB2-8 bed 2

D/Ileus Obstruksi Parsial

USG abdomen (20/11/2012) Echo cairan bebas minimalFoto polos abdomen 3 posisi (20/11/12) Tidak tampak kelainan radiologiLab 22/11/2012 GDS: 92Lab 21/11/2012 GDS: 64Lab 20/11/2012CT:8’00 BT:4’00 PT:18,1 INR:1,5 APTT:43,2 GDS:42; Ur/Kr:63/2,6; SGOT/SGPT:38/37 Prot.Total: 4,4; Alb:2,6; Na:146; K:4,0; cl:112; antiHCV: (-)WBC:22,1 RBC:3,46 HB:9,8 HCT:30,0 PLT:137

PALEM BAWAH26 Muh. Rumaf

L/58thSuspek tu.colon ascendens

Lab 21/11/2012WBC 4,89;RBC 4,84;Hb 10,3; HCT 33,7;PLT 239

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577695MRS 09/11/2012B2-11 bed 2Askes

DD/ App. Infiltrate Ur/Cr 24/1,1; Bil total 0,7; bil direk 0,15;GOT/GPT 19/16CT 9’00”; BT 2’30”; GDS 120Echocardiograf 21/11/12Fungsi sistolik LV,RV baik EF 65%LVHDisfungsi diastolikColon In-Loop 19/11/12Kesan : tidak tampak kelainan radiologis CT abdomen lower tanpakontrasKesan : colelithiasisLab (08/11/2012)CEA 1.36 (N:<2.5mg/ml)WBC 9,05 RBC 4,07 HGB 9,4 HCT 31,3 PLT 558 Na/K/Cl 137/4,0/103 Ur/Cr 23/1,3 GDS 92 Bil.total 0,3 GOT/GPT 26/36 Alb 3,5 CT 8’00” BT 3’00” PT/APTT 12,1/27,3 ALP 48Foto thorax 8/11/12Cardiomegalidengandilatasi et atherosclerosis aorta, pulmo normalUSG abd Tidaktampakkelainan

27 Tn. AsminL/ 48 tahun452437MRS: 21/11/12Kmr B1/6

Prolaps Recti Lab 22/11/12WBC 11,41 RBC 4,86 HGB 11,3 HCT 33,4 PLT 201 GDS 86 Ur/Cr 36/0,8 GOT/GDP 17/62 Albumin 3,4 CT/BT 7’00”/ 2’00” PT/APTT 9,7/20,6 Na 139 K 3,8 Cl 106CT abdomen Kesan : massa pada rectumLab (08/11/2012)WBC 12,11 RBC 5,01 HGB 11,4 PLT 306 GDS 99 Colon in loopKesan: tidak ada kelainanFoto thoraxCardiomegal idengan dilatasi et athero sclerosis aorta, pulmo normal

LONTARA 1 ATAS DEPAN29 Hasdinar

P/ 31 thn/ 470628/ MR:20/11/2012Askes

CKD stg.V Lab 24/11/12PT/APTT/INR = 12,5/23,8/1CT/BT = 7,30/3Ur/Cr = 43/8,9, Na/K/Cl = 142/2,5/106 , WBC=10,28, HGB=9, RBC=3,19

Lab (23/11/2012)WBC:15,40 RBC:3,42 HB:9,9 PLT:280 Na:138 K:2,6 Cl:104 Ur/Kr:40/9,1UGD abdomen (22/11/2012)- PNC bilateral- Kongestif liver- PID

LONTARA I ATAS BELAKANG30 Dg Baco/ 67 thn

P/ 578218MRS 20/11/2012JKMKmr 1/B4

Hemorrhoid interna grd III

Foto thorax 12/11/12Kesan : KP sinistra lama aktifLab 12/11/12WBC 7,52;RBC 4,37; HB 13,3; HCT 41,2; PLT 284GDS 125; Ur/Cr 45/1,0; GOT/GPT 19/25; Alb 4.2; asam urat 5,1; CT 7’00”; BT 3’00”; HBsAg (-);anti HCV (-).

32 A. MattalataL/59 tahun577973MRS 9/11/12

Tumor gaster CEA: 291,4Lab 22/11/12Na 138 K 4,3 Cl 105 HbsAg (-) Anti HCV (-) Ur/Cr: 18/0,8 Prot.total 6 albumin 4,3 CT/BT: 7’00”/3’00”CT-scan abdomenKesan: tumor lambung ( susp. Malignancy)

LONTARA I BAWAH DEPANLONTARA 1 BAWAH BELAKANG

33 Dg Sikki/L/42 thn568092 / MRS 22/11/12 Kamar 7/bed 6

Susp tu colon Lab 21/11/12GDS 127 Ur/Cr 80/1,8 GOT/GPT 56/18 Prot total 7,4 Alb 3,6 Globulin 3,8 HB 11,1 HCT 33 CT-scan abdomen 21/11/12Kesan: teratoma mesenterium+ hidronefrosis bilateral

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34 La Ukkase Pallelel/579484MRS 19//11/2012

Tu. Abdomen DD/ Hepatoma

Lab 21/11/2012WBC:6,93 RBC: 3,82 HB:9,4 HCT:32,1 PLT:318Lab 20/11/2012WBC 8,39 RBC 2,62 HB 6,1 PLt 275GDS 101 ur/cr 16/0,6 GOT/GPTY 46/29 alb 2,3 Na 143 K 4,60 cl 120Radiologi foto Thorax AP 20/11/2012Kesan:-susp. Tumor paru kanan DD/ Tumor metastasis ke paru - cardiomegalyUSG abdomen 20/11/2012 Kesan : Massa Pada hepar

RSP35 Martinus

L/54thnRM: 006141MRS: 14/11/ 12LT.4Kamar435

Choledosistolitiasis Lab 20/11/12: ALP 177 GGT 78 AFP 164,6 GDS 233Lab 14 /1 1 /2012: WBC 2,49 RBC 4,46 Hb 13,2 HCT 37,9 PLT 300 CT 8’00 BT 2’00 PT 18,1 APTT 39,8Ur/Cr 20/0,4 GOT/GPT 962/714 Na 134 K 3,7 Cl 106 Bil.total16,26 Bil.direk15,86 Alb3,01Foto thorax 14 /1 1 /2012 : slight Cardiomegaly USG Abd 1 2 /1 1 /2012 : cholelithiasis

36 LANAMUSA L/63THNRM : 005802MRS:1/11/12LT 4 KMR 401 B

LIMFOMA KHEMOTERAPI I

LAB 23/11/12ALB 3,32LAB 21/11/12NA 135 K 4,5 CL 107CT-SCAN ABDOMEN 24/10/12Massa mesenterium dengan perlengketan loop-loop usus disertai ascitesPleural reactor kanan

37 Tn. Kristanto/ 36thn / L/ 6052MRS : 10/11/12Lantai 401 A

Fistel perianal POH 13 Fistelektomi

Lab 10/11/12WBC 17,3 RBC 5,14 HGB 12,8 HCT 40,5 PLT 524 CT/BT 8’00/3’OO PT/APTT 12,5/22,8 GDS 63 GOT/GPT 23/56 Ur/Cr 50/1,0 NA/K/CL 140/4,32/107

38 Tn. Ahmad Fadil/ 17 thn/L/6284MRS 21/11/12Km. 419

POH 4 appendectomy Lab 21/11/12WBC 13,88 RBC 4,8 Hb 14,3 Ht 46,1 Plt 263 Na 139 K 3,6 Cl 106 PT 12,8 APTT 39 INR 1,02 GOT 18 GPT 20 Ur 18 Cr 0,9 GDS 82

39 Nurmawaty/35 thn/ P/6283MRS 21/11/12Km. 413

POH 5 appendectomy Lab 21/11/12WBC 18 RBC 4,8 Hb 14,2 Ht 46,1 Plt258 Na 139 K 4,3 Cl 106 PT 12,1 APTT 34,4 INR 0,95 HbsAg (-) GOT 25 GPT 17 Ur 19 Cr 0,9 GDS 102 CT 8 BT 3

40 HJ.SUNARTI/57thn/p/6166MRS 16/11/12KMR LT3. 303

TERAOMA RETROPERITONIAL

LAB 23/11/12HB 10.5 WBC 8,10 RBC 4,10 HCT 319 MCV 77,8 MCH 25,6 PLT 0,09 NEUT 81,2 LYMP 10,4 MONO 8,4 NA 131 K 3,5 CL 102 PT 19,8 APTT 29,6 SGOT 57,1 SGPT 44,4 UREUM 23,5 KREATININ 0,5LAB 17/11/12CT/BT 8/3APUSAN DARAH TEPI 17/11/12Anemia mikrositik hipokrom susp.FE dd/ Anemia penyakit Kronik

CT-SCAN ABDOMEN TANPA KONTRAS 17/11/12Massa komplex regio lumbal kanan Susp. Teratoma retroperitonealTHORAKS AP 16/11/12Pulmo normalCardiomegali disertai dilatasio aortae

41 SIRAJUDDINL/MRS 23/11/12

POH II LAPARATOMY EKSPLORASI + APPENDIKTOMI

Lab 23/11/12NA 134 K 3,9 CL 107 HB 13,1 WBC 25.500 PLT 414.000 ALB 2,84 GOT/GPT 15,5/27,0 GDS 109 KOL.TOT 126 AS.URAT 4,5THORAKS 23/11/12 COR dan PULMO normalBayangan udara bebas subdiafragma kesan perforasi inraperitoneum

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P C C40 Tn. Adnan

L/50 thn10793MRS 12/11/12ASKESKamar 332

Hemoroid gr III-IVDD/ Polip Recti

USG17/11/2012: fatty liverLab 14/11/12 G2PP 231 GDP 172Lab 13/11/12CT/BT 8/2 PT/APTT 10,2/23,4 HbA1C 7,6 GOT/GPT 55/66 PROTEIN TOTAL 7,6 ALBUMIN 4,6 GLOBULIN 3,0 KOLESTEROL TOTAL 257 NA/K/CL 147/4,7/109HBsAG NEGATIF ANTI HCV NEGATIF UR/CR 29/1,1Lab. 1/11/2012GDP 128 Ur 26 Cr 1,1 GOT 52 GPT 90 HbsAg –CT 8’30’’ BT 2 PT 10,6 APTT 24,8 RBC 4,66 WBC 4,9 HGB 13,4 HCT 40,8 PLT 236FOTO Thoraks 1/11/12 DBN

41 EstherP/53 thn548425MRS 13/11/12ASKES K.328

Cholelithiasis Lab 20/11/12: RBC 3,35 Hb 9,8 Ht 29,8 Plt 450 WBC 6,2CT 7 Bt 3 PT 12,2 INR 0,9 APTT 23,3 Prot.ttl 6,4 Alb 3,3 Na 131 K 4 Cl 107 USG16/11/12: cholelithiasis,pelviocaliectasis rendextraLab 13/11/12: RBC 3,27 Hb 9,6 Hct 28,9 WBC 8,5 PLT 294 Ur 21 Cr 0,8 Bil total 0,65 GOT 29 GPT 26Lab 11/11/12: GDS 99

43 HermawatyP/54 thn551631MRS 23/11/12K.331

Cholelithiasis Foto thorax (23/11/12): dlm batas normalLab 21/11/12: PT 10 APTT 25,5 GDS 85 Ur 21 Cr 0,7 GOT 15 GPT 10 RBC 4,35 Hb 13,4 Ht 41,1 WBC 8,3 PLT 264

Lontara 3 THT44 Tn. Taher L/ 58

thn / 573717MRS 21/11/12Kamar 2/6

Post op herniorafi S Lab 21/11/12RBC 3,20 HB 8,6 HCT 27,3 Na 142 K 3,39 Cl 114 GDS 112 Ur/Cr 39/1,50 Albumin 3,70 HbsAg (+)

UGD

46 Iin InayatiP/ 580276/ 21 thn/ JKD

Trauma abdomen + Tu.abdomen

Lab (24/11/2012)WBC:13,70 RBC:3,67 HB:9,8 PLT:360 Na:140 K:6,97 Cl:107GDS:107 Ur/Kr:300/21,3 GOT/GPT:13/14 Prot.tot:6,4 Alb:2,8 Glb:3,5 HBsAg: (-) antiHCV: (-) CT/BT:7’30/2’30 PT/aPTT:13,7/26,1 INR:1,09 LED I:92 LEDII:104USG AbdomenKesan:-hidronefrosis berat ginjal kiri + susp.tanda-tanda hematom intrarenal-cairan bebas intraperitoneal-susp.trauma lien-efusi pleura kanan

47 Ramli ManuaL/ 580234/ 51 thn/ Jamkesmas

Tumor abdomen Lab(24/11/2012)WBC:12,67 RBC:4,09 HB:9,4 PLT:371 Na:138 K:4,48 Cl:107 HBsAg: (-) antiHCV: (-)GDS:97 Ur/Kr:37/1,1 GOT/GPT:18/14 Prot.tot:8,5 Alb:1,8 as.urat:7,8 Bil.tot: 0,23CT/BT:8’00/3’00 PT/aPTT:13,7/26,3 INR:1,09

48 Ikhsan AchmadL/ 580276/ 21 thn/ JKD

Post op Apendectomy tanggal 24/11/2012POH 2

Lab (24/11/2012)WBC:18,06 RBC:5,55 HB:15,8 PLT:254 Na:142 K:3,98 Cl:103 HBsAg: (-) antiHCV: (-)GDS:97 Ur/Kr:20/0,8 GOT/GPT:27/34 Prot.tot:6,9 Alb:4,3 Glb:2,6CT/BT:8’00/3’00 PT/INR:10,7/0,9 aPTT:26,9 USG Abdomen (24/11/2012)Kesan: Gambaran appendicitis dengan free fluid sekitarnya

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