koran dimas 8 desember
DESCRIPTION
;kmgTRANSCRIPT
PALEM ATAS (Rita Herawany 085-242- 551-105)
No Bed dentita! "ia#no!i! Pe$eri%!aan Pen&n'an# Terai 1 B1*
+, Ny "arna TL 2.- 02-1,55 MRS 18*11*201/ RM .205/
AS+ES
E7o7ardio#ra$ .*12*201/ +e!i$&3an
- "i!9&n#!i dia!to3i% L: - E; .8< ;oto tora 02*11*201/
- "i3atatio aortae - E9&!i 3e&raa !ini!tra - P3ate 3i%e ate3e%ta!i! ar& %anan MR a6do$en 22*11*201/ +e!an - Tida% ta$a% %o3e!tati% intra dan
e%!tra eati% - Bat& d&7t&! 7y!ti7&! di!ertai
7o3e7y!titi! - Heato$e#a3y - n7identa3 =ndin# 9ra%t&r
%o$re!i : T 10-11 ;oto tora 20*11*201/ +e!an - P&3$o nor$a3 - ardio$e#a3y di!ertai di3atatio aortae
La6 1,*11*201/ H6A17> 5?2? a3%a3i 9o!9ata!e ,54? @a$$a @T 0? Na*+*3 145*4?*10,? PT 1/?0 7ontro3 12?.? APTT 2,?4 7ontro3 24?4? NR 1?08
La6 12*11*201/ RB 4?5. H@B 12?5 HT /?0? PLT /./ B ,?0 @"S 1/? @2PP 1/2? &r*7r 1/*0?,0 A!&rat /?5 Bi3tot 5?21? 6i3dire% /?/ @T /85? @PT /44
T a6do$en 12*11*201/ @a33!tone o3e7y!titi! Heato$e#a3i
- @: ari ini - n' 7e9triaon 1
#r* 12'* : - Ranitidin ta6
- "iet rend 3e$a%
2 B2* +4*2
Ny Sa33a$a /1*12*1,.. 4. Ta&n ./.81, MRS 12*11*201/ +NSL 14*11*1/ A!%e! a'i6
"rdr 6rai$ La6eda? SB +B"
Adeno7ar!in o$a o3on A!7enden! Re!idi9
La6 /*12*201/ @3o6&3in /?? @"S 250? r*r 11*0?5,? S@T*S@PT 28*2.? Prottota3 .?1? A36&$in 2?4? T*BT ,C00*4C00 PT 15?4 7ontro3 12?4? NR 1?24? APTT 25?0 7ontro3 24?0? Na*+*3 124*/?,*, La6 02*12*201/ B 1/?? RB /?45? H6 ,?/ HT 2?0 PLT ./2? @"S 250? r*r 11*0?5,? S@T*S@PT 28*2.? Prottota3 .?1? a36&$in 2?4? #3o6&3in /?? PT*APTT 15?0*25?0? NR 1?24? T*BT ,?00*4?00 Na*+*3
1 "iet 6e6a! !&!& eti!o3 / 250 77
2 n'e%!i !oo6ion 1 a$*12 '* dri!
/ ti$a3i!a!i +
1
SABTU, 7 DESEMBER 2013 124*/?,*,?
La6 /0**11*201/ B 15?45? RB 4?1? H6 10?.? HT /1?4 PLT 5,8? Na*+*3 1/1*/?.*11/ La6 2*11*1/ @"S 150? Na*+*3 128*4?0*104 La6 2.*11*1/ B 1/?4? RB /?8 H6 ,?8? HT 2,?4 PLT 525 La6 22*11 *1/ B 1.?2 H@B ?8 RB /?1/ HT 24?8 PLT .?58 (Ane$ia $i%ro!iti% io%ro$? tro$6o!ito!i!?3e&%o!ito!i!) o3on n Loo 21*11*201/ Tida% ta$a%7o3on a!7enden! dan 1*/ roi$a3 7o3on tran!Der!&$ La6 1,*11*1/ B,?5?H@B11?0?HT/0?.?PLT55/ La6 18*11*1/ EA 1?8? A 1,-, ,?,, La6 1.*11*1/ B14?/?H@B,?11?HT2??PLT5 0 Ha!i3 PA 10*0.*1/ Adeno7ar!ino$a 7o3on ? $oderate3& dierentiated den#an %ed&a &'&n# re!e%!i 6e6a! t&$or ;oto tora%! PA 1/*11*1/ Tida% ta$a% tanda tanda $eta!ta!i! ada 9oto tora% ini MST !7an a6do$en 1/*11*1/ Ma!!a 7o3on a!7endena! den#an tanda tanda o6!tr&%!i &!&! di roi$a3nya Heato!eno$e#a3i? tida% ta$a% tanda tanda $eta!ta!i! %e ear La6 1/*11*1/ Na*+*3 1/5*4?2*108? Bi3ir&6in tota3 0?1? Bi3ir&6in dire% 0?1? A3%a3i 9o!9ata!e .,? @a$$a @T 18
/ B2*.* 2
ASKES
T&n##& a!i3 3a6 - La6 3en#%a - ;oto tora
(!enin)
4 B2* +8*1
S&ardin 1*0*1,.0 5/ Ta&n .//,51 MRS 2/*10*201/ +NSL 1*11*1/ A!%e!
PH 24 Laarto$i e%!3ora!i e$i7o3e7to $i (") draina!e a6e! i3e&$ ter$ina3a6
La6 2*12*201/ +&3t&r Sen!iti9 A$i%a7in? 3ora$9eni7o3? ;o!9o$i7in? @enta$i7in? Meroene$ La6 2.* 11* 201/ @T /2? @PT ,? A36&$in 2?5 La6 15*11*1/ A36&$in 2? B /8?0/ RB 2?,, H@B ,?1
- @: d#n wo&ndre!!
- "iet tin##i rotein
e! ear a6!e! erine9ri%
"M tie 2
den#an &ndierentiated 3eo$or=% !ar7o$a La6 14*11*1/ r*r 22*0?/ @T*@PT 11*, Na*+*3 1/2*4?/*10/ PT 14?2 7ontro3 11?2 NR 1?08 APTT 2?2 7ontro3 2/?2 La6 PA 1/*11*1/ - Ma3i#nant ;i6roi!tio7yto$a (T&$or n#&ina3) - A67e!! (Farin#an Boto3) La6 11*11*1/ @"S 1/2 @T*@PT 48*1/ A36&$in 2?4 T*BT 8C00CC*/C00CC PT 1?5 7ontro3 12?4 NR 1?44 La6 08*11*1/ @"S 1, r*r 10*0?. @T*@PT 11*. Protein Tota3 5?8 A36&$in 2?0 T*BT 8CC00C* /G00C H6 8?1 B 4/?/ RB 2?,4 PLT //. PT 1,?, 7ontro3 11?4 NR 1?./ APTT 40?. 7ontro3 2.?2 Na*+*3 1//*4?/*, La6 .*11*201/ B /1 RB 22, H@B .2 HT 1 PLT /.0 @"P //8 @"2PP 121 La6 2/*10*201/ @"S 15 r*r 1*05 S@T*S@PT 1*20 Na*+*3 12.*4/*,, T*BT 8*/ PT*APTT 14,*/08 HB!A# Rea7tiDe Anti H: non rea7tiDe La6 24*10*201/ EA 10. T !7an a6d tana den#an %ontra! /1*10*201/ - Hidrone9ro!i! dan !oa! a6!e!
%anan - +i!ta ear di!ertai
eato$e#a3y S@ te!ti! 28*10*201/ Hydro7e3e detra S@ a6d 2/*10*201/ Ma!!a intraa6do$ina3 !i!i %anan di!ertai e3Do7a3ye7ta!i! detra Tora PA 2/*10*201/ - or dan &3$o nor$a3 - 3d 9ra7t&re 1*/ ten#a 73aDi7&3a
%anan? 7o!ta -: %anan 6e3a%an# dan 7o!ta :-: %iri 6e3a%an#
/
5 B2* +, B1
ST M&nawarra (.0 tn) RM ./ -,.-8 TL /1*12*1,52 MRS 2,*11*201/ +on!&3 /0*11*201/ AS+ES
"rdr6rai$ La6eda SB +B"
S&! Aendi7iti! %roni% o6!erDa!i ari %e 8
La6 04*12*201/ A$y3a!e an7reati7 /5? Lia!e 50 La6 /*12*201/ @"P ? @"2PP 1, La6 01*12*1/
+o3tota3 440? +o3H"L 2,? tri#3i!erida 11, S@ A6do$en /0*11*201/ +e!an #a$6aran aa%&t d#n aendi7o3it
La6 2,*11*1/ B 11?48? RB 4?00? H612?4? HT /4?,? PLT /11?? @"S ,,? r*r 25*0?? S@T*S@PT 20*21? Prottota3 .?8? a36&$in 4?4? #3o6&3in 2?4? Na*+*L 1/,*/?8*11.
rin r&tin 2,*11*1/ arna %&nin# $&da? P .?0? B' 1?105? rot?(-)? #3&%o!A (-)? 6i3ir&6in (-)? %eton (-)? nitrit (-)? B3ood *10? 3e%o!it (-)? !ed$en 3e%o!it 0-1? eritro!it 0-2? !edi$en %ri!ta3 0-2
- T S7an A6do$en - Nor$a3 Dia %o$&ter
- Ren7ana 3aora!%oi 6i3a a!ien !et&'& ari ra6& t#3 11*12*201/
. B2*10 B2
A$ri (4. tn) RM 54 4 . TL 15*/*1,. MRS 05*12*201/
AS+ES
Hernia in#&ina3i! (S) reoni6i3i!
La6 2,*11*201/ B ,?2? RB 4?.? H6 14?0? HT 40?5? PLT 425? T*BT 8C00*/C00? PT 12?, 7ontro3 12?5? NR 1?0? APTT 2?5 7ontro3 2?4? Na*+*3 142*4?/*10,? @"S 8? r*r 2.*1?54? a!a$ &rat 8?5? S@T*S@PT 25*42? H6!A# dan anti H: (-)
;oto tora 2,*11*201/ Tida% ta$a% %e3ainan radio3o#i% ada 9oto tora ini
S@ a6do$en 18*11*201/ +e!an - S3&d#e @B - S3eno$e#a3y
- Ren7ana 'adwa3 oera!i Ra6& 11*12*201/
- +on!&3 re&$ato3o#y? a!$ &rat (8?5)
PALEM BAAH (Rita Herawany 085-242-551-105)
B2*1 Bed 2
Tn"ira$ RM .2 24 8 TL 0*0/*1,45 MRS 28*11*201/ +on!&3 2,*11*201/
AS+ES
E9&!i 3e&ra (") H; e7 A"
La6 5*12*201/ @"S 112? r*r 41*1?15? S@T*S@PT /1*1? +o3tota3 ,,? +o3H"L dire7t 10? +o3L"L dire7t 4/? Tri#3i!erida 1.? TSH ?.,? ;T4 1?/8 La6 4*12*201/ B ,?4? RB 4?.0? H6 12?5? HT /8?2? PLT ..0 S@ 2,*11*201/ +e!an "i3ata!i 3oo-3oo &!&! d#n eri!ta3ti7
- da rawat !a$a TS endo%rin $eta6o3i%
- "iet 6&6&r - T&n##& 'awa6an
7o3ono!7oy - :i a36&$in /2
7a! - ti$a3i!a!i +
"i!tendid @B den#an !3&d#e di da3a$nya
+i!ta #in'a3 %iri E9&!i 3e&ra !ini!tra Tida% ta$a% 7airan 6e6a! 7aD&$ eritone&$
/5?? PLT 58? PT 18?, 7ontro3 10?0 NR 1?5.? APTT /.? 7ontro3 24?0 @"S 1,0? R*r ..*1?2? S@T*S@PT 2.*1,? Prottota3 .?2.? a36&$in 2?0? #3o6&3in /?5.? a!a$ &rat ,?. ? Na*+*3 1/0*/?.*114
8 B2* +5*1
M&7tar Ta$6i Tan##a3 3air /1-5-1,48 RM ./8.. Tan##a3 $a!&% 28-11-201/
A!%e!
"rdr 6rai$ La6eda? SB (+B")
%ter&! o6!tr&%!i e7 !&! !tenoti7 B" ""* t& a&t an%rea!
La6 /*12*201/ B ?20? RB /?1? H6 12?? HT /4?2? PLT /1,? T*BT 8C00*2C00? PT 12?1 NR 1?01? APTT /0?0? @"S 81? R*r /,*1?1/ Bi3tota3 18?4.? 6i3dire7t 1.?40? S@T*S@PT 4,*42? a3%a3i 9o!9at 2,? @a$$a @T 52? Prottota3 5?8? a36&$in 2?,? Na*+*3 1//*4?.*10/? HBSA# (-)? anti H: (-) MR 2.-11-201/ Ha!i3 - Steno!i! B" di!ertai %o3e!tati%
intra-etraeati7 dan di!ten!i @B - o3e7y!titi!
La6 2.-11-201/ a 1,-, 2//?22?
La6 25-11-201/ PT 11?5 7ontro3 12?5? APTT 28?8 7ontro3 2?1
La6 20-11-201/ @3&%o!a to3eran!i 8,*1,0 HBA17 4?/ A3%a3i 9o!9ata!e /.2 @a$$a@T 124
La6 18-11-201/ @"S 12? &r 4.? r 1?2? 6i3tot ,?. Bi3dire% .? @T 5.? @PT 0 T 8C00 BT 2C00 PT 15?2 APTT /0?0 NR 1?2. Natri&$ 1/? +a3i&$ 4? 3orida 104? B ,?82? RB /.? H@B 1/?0 HT /4?? PLT 41.
T !7an a6do$en (tana %ontra!) 1,- 11-201/ Ha!i3 7o3e!tati7 intra dan e%!traeati7 e7 !&! 3&!7ent !tone! ada di!ta3 B" (""*Steno!i! B")
- :i a36&$in /2 - +on!&3 erioerati9 oti$a3 &nt&% oera!i
- Fawa6an HM oti$a3 &nt&% di3a%&%ana oera!i
- Ren7ana oera!i ari %a$i! 12-12- 201/
5
SABTU, 7 DESEMBER 2013 , B2*
+8*2 Ninin# 18*01*1,4 /, Ta&n MRS 22*10*1/ +NSL 2*11*201/ AS+ES
"r dr 6rai$ La6eda? S B- +B"
PH /. Mi3eC! Pro7ed&re e7 a re7ti 1*/ di!ta3
Ha!i3 MR (22-11-201/)
3eDe3
"e9e7t ada 3inea $ediana (6e%a! oera!i) anterior De!i7a &rinaria
Tida% ta$a% =!te3 dari re7t&$ %e
Da#ina $a&&n :e!i7a &rinaria Ha!i3 PA (08*11*1/) Adeno7ar!ino$a $&!ino!&$ dieren!ia!i 6ai% den#an 1 &'&n# re!e%!i $a!i $en#and&n# t&$or /1*10*1/ B /2?5. RB /?/ H@B 10?2 PLT /22 22*10*1/ T*BT 8*/ PT 11?5 7ontro3 10?5 NR 1?00 APTT 24?8 7ontro3 25? Na*+*3 145*/?.*110 S@ (22*10*1/) Ma!!a re7t&$ Tida% ta$a%tanda tanda $eta!ta!i! ada S@ !&3 MST-S7an A6do$en den#an %ontra! ;oto tora%! (22*10*1/) Tida% ada tanda tanda $eta!ta!e ada 9oto tora%! ini La6 22*10*1/ r*r 40*0?, @"S 188 @T*@PT 1.*8 Prottota3 5?/, A36&$in 4?23 T A6do$en (22*10*1/) +e!an $a!!a di!ta3 re!e!&ai d&%! A
- iroIoa7in 2500 $#
- "&ro#e!i7 at7 12?5 $#
- Mo6i3i!a!i 'a3an - T&n##& a!i3 %&3t&r
10 B1* "anie3 Pa%o6on# T#3 3air 15*08*1,5. (5) MRS 25*11*1/ MR ./.550
AS+ES
"rdr Rona3d L?SB-+B"
PH 10 3aaroto$y dan !i#$oide%to $i e7 adeno 7a !i#$oid
La6 28*11*201/ B 22?4/? RB 4?./? H6 14?1? HT /8?,? PLT /15 La6 2* 11* 201/ B ?? RB 4?1,? H@B 12?,? HT /8?/? PLT 2,,? PT 1/?2 (7ontro3 10?8)? APTT /1?4 (7ontro3 24?0)? @"S ./? &r*7r 28*1?0/? @T*@PT 2/*2/ La6orat&ri&$ 25-11-201/ E3e%tro3it? Na 1/.? + /?,? 3 111 MST !7an A6do$en Ma!!a retro!i#$oid (d&%e! A) Ha!i3 PA 1,*11*1/ Adeno7ar!ino$a retro!i#$oid La6 11*11*201/ B ?4 RB 4?25 H@B 14?4 HT 41?2 PLT /20 @"S 11,? &r*7r /4*0?8 @T 22 @PT 2/ EA 0?., PT 12?5 (7 12?4) APTT 28?. (7 22?) S@ 11*11*201/ - Tida% ta$a% tanda-tanda
$eta!ta!i! ada S@ a6do$en ini Hiertro= ro!tat
- :;" RL 28 TPM - n' 7e9triaone 1
#r*12'*D - n' antoJo3 40
$#*12 'a$*iD - Min&$ 6e6a! - "iet 6&6&r
!arin# - S&!& eti!o3
/250 77 - Mo6i3i!a!i 'a3an
+10* B2
$i ani $&#ni T#3 3air 11*12*1,4 RM ./ 82 Tan##a3 $a!&% 25-11-201/
A!%e!
PH 4 e%!3ora!i B"
La6 02*12*201/ T*BT 8?00*/?00? PT 11?,? NR 0?,,? APTT 25?0 La6 25-11-201/ ;t4 1?8,? TSH! 1?54? T 8C0G? BT /C00G? PT 1?. 7ontro3 11?8 NR 1?45? APTT /1?5 7ontro3 2?
La6 18*11*201/ B 8?. H@B 1/?8? RB 4?5,? HT /8?? PLT /00 A36&$in /?, +o3 tota3 2/5? H"L ?/? L"L 140? T# .14? @"S 11 Na 1/? + /?,? 3 101 r*7r 1/*0?8 Bi3 tot 21?8/ Bi3 dire% 18?54? @T 45 @PT //
- :;" RL 28 t$ - iroIoa7in 1
%o39*12 'a$*iD - Ranitidin a$*8 'a$*iD
- +etoro3a7*8'a$*i D
- Ta%ar rod T K T&6e drain *12 'a$
- Ma%an dan $in&$ 6ia!a
- Mo6i3i!a!i d&d&%
12 B2/ K14/B1
Ny.Atika Usman (61 tahun) RM 63 80 34 MRS 1/11/13 21/04/1!2 K"nsu# 26/11/2013
ASK$S
%kt&'us "st'ukti &.* +u.*a,ut ,an*'&as
a 04/12/2013 B !3 RB 36 10! + 313 + 168 +/B+ 8500/2530 + 13 (103) %NR 11! A++ 30 (21) Na/K/# 13/24/10 7S 113 U'/' 10/064 Bi#.t"ta# 206 Bi#.i'&*t 181 S9+/S+ 48/1. '"t.t"ta# 60 a#umin 2! a 01/12/2013 B 18 RB 340 100 + 16 + 26 +/B+ 800/200 + 12! *"nt'"# 100 %NR 100 A++ 3!0 *"nt'"# 2!0 Na/K/# 138/2/114 7S 132 U'/' 14/06 Bi#.t"ta# 14 Bi#.i'&*t 1!6 S9+/S+ 63/21 ,'"t.t"ta# 63 a#umin 22
a 2!/11/2013 + 136 *"nt'"# 12! A++ 314 *"nt'"# 21 %NR 113 a#umin 24
MR% A"m&n 2!/11/2013 St&n"sis ista# B7 is&'tai k"#&statik int'a- &kst'ah&,atik an ist&nsi B
US A"m&n 22/11/2013 K&san - h"#&statik int'a an &kst'ah&,atik is&'tai
ist&n& B - A*it&s a 20/11/2013 B 3 RB 303 86 + 2!2 + 2!4 Bi#.t"ta# 16 Bi#.i'&*t 1644 A#ka#i "satas& 21 amma + 234 $A 246. A 1- 14463 ama'an 7a'ah +&,i K&san An&mia n"'m"sitik n"'m"k'"m sus,.kausa an&mia ,&nyakit k'"nik is&'tai #&uk"sit &n:an tana-tana in&ksi.
a 1/11/2013 B 1060 RB 326 0 + 240 + 244 +/B+ 830/330 + 62! *"nt'"# 10 %NR 4 A++ !4 *"nt'"# 230 7S 8! U'/' 11/0! S9+/S+ 6/2! ,'"t.t"ta# !8 a#umin 1 Na/K/# 13/23/10 BsA: (-) anti ; (-)
+ A"m&n 1/11/2013 K&san h"#&statik int'a an &ksta'ah&,atik &* sus,. St&n"sis ista# B7 77/ am,u##a <at&'i
="t" th"'a> 1/11/2013 K&san - ,u#m" a#am atas n"'ma#
-%n?.;it K 1 am,/%M - K"nsu# ,&'i",&'ati &#um ",tima# -
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 - *a'i"m&:a#y &n:an i#atati"n &t &#"n:ati"n a"'ta&
LNTARA (aty 082-/4,-0-101 ) 12 L1 AB
+$r
3e&! o6!tr&%ti9 artia3 -A!7ite! -i%ter&! Tro$6o!itoen ia
01*12*201/ ;oto a6do$en / o!i!i -!e!&ai #a$6aran i3e&! o6!tr&%ti9 3eta% tin##i (SB) -!&!A!7ite! ;oto Tora PA*AP -E9&!i 3e&ra detra BN / o!i!i -Air ;3&id 3eDe3 () -"i!tri6&!i &dara "i!a3&ran() $en&r&n
-Hier6i3ir&6ine$ia -enin#%atan EnJi$ Tran!a$ina!e
Bi3ir&6in tota3 ,?4 Bi3ir&6in "ire% 5?. @T 84 @PT PLT .1000 PT 2/?2 APTT 44?4 NR 1?84 Na1/2 +/?, 3115 A36&$in 2?4 H6!A# ()
67 5?/ R67 /?/0 H@B11?4 HT/1?, MH/4?5 MH/5?
1/ L1BB +5 %e3a! 6ed /
Nyi!a TLn/1*12*1, RM ./44 MRS 15*11*201/ F+M "i%on!&3 dari interna tan##a3 /*12*201/
"* o3e3itia!i!
12?0 HT/.?2 PLT/55
La6 24*11*201/
S@ wo3e a6do$en 21*11*201/
+e!an 7o3e3it? idrone9ro&reter %anan
+i!ta #in'a3 %iri
S&! retero3it detra
La6 0/*12*201/ 67 .?0 H6 12?0 PLT /55 r // r0?80
Saat ini a!ien $a!i 6er&ndin# &nt&% di3a%&%an tinda%an 7o3e!i!te7to$ y
14 L1A" +5 Bed 2
N&r aini RM ./ 8, 20 TL /0*12*1,.0 F+" MRS 25*11*201/ %on!&3 4*12*201/
%ter&! o6!tr&%ti9 e7 !&!6at& B"
MRP (d#n %ontra!) /*12*201/
- Ma!neter d 7o3e!eo an%rea!
- Steno!i! &'&n# di!ta3 B" di!ertai
%o3e!tati% intra-e%!tra eati7 dan
di!ten!i @B
a6do$en ini
- Laor traineer 6eda di#e!ti9
8
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 B 10?/.? RB7 4?8/? 6 1/?/? HT
/,?,? PLT /85? @"P ,0? @"2PP ,4
a3%a3i 9o!9at ./0? @a$$a @T ,82?
%o3tota3 245? %o3H"L 25? +o3 L"L 144?
T@ 15,? PT *APTT 12?2*2?0? NR 1?02?
Anti H: (non rea%ti9)? H6!A# (-)
r*r 1*0?8? Bi3tota3 4?/? Bi3dire7t
/?52? S@T*S@PT 18*18,? Na*%*L
1/,*/?2*112 15 L1 AB
%/**B .
Ha$%a P 02-02-1,52 .1 Ta&n ./852, +on!&3 interna 05*12*201/ FAM+ES"A
T& 1*/ re7t&$ di!ta3 re7t&$ d#n $eta!ta!i! %e ear ("&%e! " ) !3eno$e#a3i
T o3e a6do$en ("en#an %ontra!)
- T& 1*/ re7t&$ di!ta3 re7t&$ d#n
$eta!ta!i! %e ear ("&%e! " )
!3eno$e#a3i
HT/0?5
PLT2/.
S@PT14 A36&$in 2?. TB-141
-
Mar#ono 11-0/-1, .405/1 +on!&3 interna 0.*12*201/
+" !t# 5 e7 Ne9roati HT on AP" Hioa36&$ine $ia (/?0)
04-12-201/
@3o6&3in2?5 @"S,5 r105 HB4?1
PLT188 &r1.5 7r12?4
-
LNTARA 2 "@EST:E +AMAR 1 RMA (0852422484.8
1 Bed 1
FAM+ESMAS
PH 1/ 3aaroto$i e3ora!i e7 7o3e!i!to'e'& no!to$i Bra&n ana!to$o!i!
La6 5*12*201/
HT22?5 PLT41/ PT*APTT 12?1*2.?8
T*BT 8C00*/C00 @T*@PT 124*41
NR 1?01 6i3tota3 ?/5 6i3dire% 5?,8
#d! 112 Na*+*3 1/4*/?/*10/ r*r
2.*0?50 a3%a3i o!at 188
La6 28*11*201/
@T*@PT 11*2, ? a3%a3i o!at
22/? @a$$a @T 1
7t*6t C00*2C/0 t*at 11?0*/0?1 inr
0?,2 6i3 tot 2/?/ 6i3 dire% 24?8 #ot*#t
.8*18 a36 /?1 w67 /?44 r67 4?22 6
12?, D7t /5?4 3t 4//
E7o (18*11*201/)
+e!an
- di!9&n#!i ddia!to3i%
La6 1/*11*1/
PT 12?/ APTT /5?/
,
+L TTAL 252 +L H"L ?4 +L
L"L 1// TR@LSER"A .14
La6 8*11*1/
;S;ATASE 215 @AMMA @T 48
La6 *11*1/
/4?0? PLT /,4 H6!A# (-)? anti H:
(-)?@"S 1/2? &r*7r 1/*0?8? Bi3 Tot
20?/? 6i3dire7t 21?.1 S@T*S@PT
21*4? rottot 4?8? a36/?0? #3o6&3in
1?8? PT*APTT 24?8*41?,?
;T THRA *11*201/
+e!an
!&! Se!i=%
et e3on#a!i aortae
S@ A6d 11*11*201/
+e!an
eati%
(11*11*201/)
eati% e7 S&! $a!!a 7a&t
an%rea!
- Hyertroy ro!tat
18 Bed 2 Tn "#Nai 14*12*1,58 ./4,48 28*11*201/ F+M "rar!in##i? SB +B"
A* e$ato$a !7rot&$ o!t erniora=
La6(28*11*201/)
@"S 8 r*r 1.*0?. ? @T*@PT /5*.1? Na*+*3 1/*4?4?*11? RB 41.*HB 12?1? HT /?? PLT ///? B 10?1
RLNa3 10001000 t$ +etoro3a7 1 a$*8'a Ranitidine 1 a$*8'a "iet 6ia!a NonIa$in /1 e9triaon 1 #r*12'a MetronidaJo3e 0?5 #r*8'a$*iD
10
SABTU, 7 DESEMBER 2013 Bed / &n&! Oa#oto
1,*12*1, .40.8. 5*12*201/ $&$ "rdr6rai$ La6eda?SB- +B"
Periaendi7 &3ar in=3trat
La6 5*1*2201/ B 15?4 RB5?/2 H@B1.?/ PLT /10 T 8C00G BT /C00C PT*APTT 10?4*2?8
S@ a6do$en 5*12*201/ +e!an !3i#t eato$e#a3y den#an 9atty 3iDer tanda-tanda eriaendi7&3ar in=3trat
:;" RL 28 t$ e9triaon 1#r*12'a$ Ranitidine a$*8'a$* MetronidaJo3e 0?5 #r*8'a$*iD
SLAS (RSMA 082/48204048) 20 !o
Bed 2
Tn o3e "# Baa L*01-0-1,5.*./ tn ./81 MRS 1,-11-201/ F+M "rdr 6rai$ 3a6eda? SB- +B"
S !e!a% + !edan# A6do$en !&e3? eri!ta3ti7 ()? 3&%a oera!i %erin#? BAB ()? BA+ 3an7ar
A PH 1. Laaroto$i e%!3ora!i eritoniti! #enera3i!ata e7 er9ora!i #a!ter
La6 21-11-201/ B 8?1 RB 4?15 H@B ,?0 HT 2,?, PLT 2.0 La6 20-11-201/ B 1.?, RB 4?2 H@B 8? HT 28?, PLT /04 La6 1,-11-201/ B 1,? RB 4?28 H@B 8?8 HT /0?0 PLT /10 @T*@PT 24*1/? Prottot .?/ A36 2?, Na*+*3 140*4?2.*111 HB!A#*AntiH: (-) S@T*S@PT 24*1/ rotein tota3 .?/ a36 2?, Na*+*3 140*4?2.*111 H6SA# non rea7tiDe Anti H: non rea7ti7e T*BT ,*/ PT*APTT 1/?1*//?, @"S 115 &r*7r 42*0? S@ A6do$en (1,*11*201/) +e!an airan 6e6a! intraeritone&$
RL 5001 e9triaone 1#r*12'*iD San$o3 1#r*8'*iD MetronidaJo3e 500$#* Ranitidin 1a$*8'*iD Bi!o3Don 1a$*8'*iD :i a36&$in /2 ta6 Terai !e!&ai t! BT+: n9&! +L 1 I7 da3a$ N 0,< 50077 n9 A36&$in 20< 1 6t3*
21 !o Bed
1
Tn P&t& Adnyana L*2,-12-1,,*2/ tn /588,4 MRS 2,*11*201/ F+M
S - + 6ai% A6do$en !&e3? eri!ta3ti7 () !to$a 6ai% rod 9e!e! () A o!t 7o3o!to$y
La6 12-11-201/ B 5?8 RB 4?8 H@B 15?. HT 42? PLT 220 @"S ,5 r 15 r 1?0 @T 1/ @PT 10 Na 1/, + /?8 3 102 T 8C00 BT /C00 Pt 1/?, APTT 2.?, HB!A# (-)
Pe$eri%!aan Loo#ra= (1/-11- 201/) Po3o! A6do$en "i!tri6&!i &!&! !a$ai %e di!ta3 den#a 9e7a3 $ateria3 yan# !an#at 6anya% Tida% ta$a% di3ata!i 3oo-3oo &!&!? #a$6aran errin# 6one +ed&a !oa! 3ine inta% +ed&a re eritonea3 9at 3ine inta% T&3an#-t&3an# inta% ;oto 3oo#ra= +ontra! 6ari&$ !e6anya% 100 77 di$a!&%%an $e3a3&i %ateter %e da3a$ !to$a? tana taanan $en#i!i 7o3on de!7enden? 7o3on tranDer!&$? ta$a% &3a $en#i!i
Pro 7o3o!to$y 73o!&re
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 $7o3on !i#$oid? re7t&$ %e$&dian %e3&ar $e3a3&i an&! M&%o!a 7o3on re#&3ar? 7a3i6er 3&$en dan a&!tra!i 6ai%? tida% ta$a% =33in# de9e7t $a&&n additiona3 !adow ;oto 7o3on in 3oo +ontra! 6ari&$ !e6anya% 100 77 di$a!&%%an %e da3a$ %ateter $e3a3&i an&!? ta$a% $en#i!i re7t&$? 7o3on !i#$oid? !e6a#ian 7ontra! %e3&ar $e3a3&i !to$a!e6a#ian $a!&% $en#i!i %o3on M&%o!a 7o3on re#&3ar? %ai6er 3&$en dan a&!tra!i 6ai%? tida% ta$a% =33in# de9e7t $a&&n additiona3 !adow
T !7an A6do$en (11-11-201/) "e9e% dindin# anterior a6do$en re#ion 3&$6a3i! %iri r#an-or#an intraa6do$en yan# ter!7an da3a$ 6ata! nor$a3
;oto Tora PA (11-11-201/) Tida% ta$a% %e3ainan radio3o#i ada 9oto tora ini
LNTARA 2 "@EST:E +AMAR 2 (EML 0852,,,2,,1/) 22 Bed 1 Si$on ;i33a
L*18-08-1,8 RM ./5082 MRS /1-10- 201/ F+M %on!&3 interna 12*11*201/ "r dr Rona3d? SB +B"
PH / 3aaroto$i e%!3ora!i RS "F !tent de%!tra e7 T& o3on A!7enden !&! $a3i#nan7y idrone9ro!i! detra
La6 25*11*201/ B /?5 RB /?, H@B 10?5 HT /1?5 PLT 4.4 T*BT 8*/ PT*APTT 14?1*/0?8 @"S 85 r*r /1*0?8 @T*@PT 52*5 Prot Tot .? A36 2?, La6 18*11*201/ B 8?., RB /?,? H6 10? HT/2?1 PLT 501 #ot*#t .*51 &r*7r /2*0?, La6 14*11*201/ B 8?24 RB /?/8? H6 ,?.? HT 28?5 PLT /,. ;e 0? Bi3 Tot 0?./? 6i3dire7t 0?4. S@T*S@PT 5*50 NR 1?0 a3%a3i 9o!9ata!e 8., a36 2?. #a$$a #t /4? rottot 7t*6t 8C00*/C00 PT*APTT 12?*20?8 o3on in 3oo 15*11*201/ +e!an t&$or 7o3on a!7enden! !a$ai Ie&ra eati7a
Endo!%oi (11*11*201/) +e!an He$orroid interna #rade T& 7o3on a!7enden! !&! $a3i#nan7y MST o3e a6do$en (non %ontra!) (01*11*201/) +e!an S&! $a!! ada 7ae7&$ in##a
RL Na3 "5 111 2 t$ Ranitidine 1a$*8'*iD +etoro3a7 1 a$* 8'*i e9triaone 1 #r*12 ' Ranitidine 1 a$*8' MetronidaJo3e 1 a$3*8'a$*iD
12
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 Ie&ra eati! 7o3on a!7enden!? den#an e$adatan $&n#%in !&at& er3en#%etan den#an 3oo-3oo &!&! di!e%itarnya Hydronero!i! detra ;oto Tora PA 01*11*201/ +e!an tida% ta$a% ro!e! $eta!ta!i! ada 9oto tora ini
2/ Bed 2 Tn wan 1--1,/ ./8/,5 MRS 20*11*201/ "rdr Rona3d SB +B"
T&$or Sa7ro7oy#e a3
La6 28*11*1/ B ,?21 RB 4?1/ HB 11?2 HT //?. PLT 28 A36 /?8
T a6do$en 21-11-1/ - Ma!!a !a7r&$ yan#
$ende%!tr&%!i o! !a7r&$ dan $e3&a! %e ron##a e3Di! !&#e!ti9 7ordo$a
- Hidrone9ro!i! di!ertai idro&reter 6i3atera3
;oto o3on in3oo 2-11-1/ o3on in3oo da3a$ 6ata! nor$a3? %e7&a3i ene%anan 6a#ian re7to!i#$oid o3e $a!!a
La6 20*11*201/ B 11?44 RB /?20 H@B 8?2 HT 24?, PLT /04 @"S 11, r*r 44*2?40 @T*@PT 28*11 Prot Tot .?0 A36 /?0 +o3 Tot 214 +o3 H"L // +o3 L"L 150 T@L 114 Na*+*3 145*/?,*108 S@ A6d 20*11*201/ Ma!!a %o$3e%! ron##a a6do$en yan# $enye6a6%an indenta!i dindin# o!terior 6&3i-6&3i dan ydrone9ro!i! 6i3atera3
-Ranitidine 2 150 $# B7o$ 21 T#& 'adwa3 o
24 Bed / B&di$an .-12- 1,81 ./,424 MRS 2*11*201/ F+" "r Sa$&e3 SB +B"
A!7ite! eritoniti! TB
H6 o!t tran!9&!i ,?, La6 1*12*1/ B ?. RB /? H6 ,?, HT /0?8 PLT /8. La6 2*11*201/ B ,?0 RB /?.4 HB ,? HT /0?, PLT 480 T*BT 8*2C/ PT*APTT 11?,*2,?5 r*r /*0?. @T*@PT 52*5 Na*+*3 1/5*4?2*10 2-11-1/ T !7an a6d a!7ite! eritoniti! ;oto tora ardio$e#a3y di3ata!i aorta E3eDa!i dia9ra#$a
RL Na3 A$$inoI& 111 28 t$ :P a36 /2 ta6 San$o3 1 #r*8'*iD LeDoIoa7in 1 #r*12 ' Ranitidine 1 a$*8' MetronidaJo3e 1 a$3*8'a$*iD
25 Bed 4 Ma'id Paa3ia 10*0*1,.2 RM .//0 MRS 24*10*201/ "i%on!&3 dari T! interna t#3 28*10*201/
"* PH 1. #a!tro!to$i 9eedin# e7 t& E!oa#&! 1*/ di!ta3
La6 /*12*1/ B 4?. RB /?2. HB 8?, HT 2.?8 PLT 1,, La6 (/0*11*1/ B .?2 RB /?0/ H6 8?/ HT 25?1 PLT 14/A36 2?4 La6 (21*11*201/) B 5?.? RB /?2.? HB ,?/ HT 2?/?
:;" RL a$inoI&id Na3 0?,< 111 2 t$ Metronida!o3e 0?5#r* Ranitidin a$*8'*iD e9triaone 1#r*12'*i "iet !&!& 100 77*2'
1/
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 "rdr6rai$ La6eda SB +B"
T&$or e!o9a9&! !&!e% $a3i#nan7y T o3e a6do$en tana %ontra! (25*10*201/ +e!an ene6a3an dindin# #a!ter !&!e% $a!!a eato$e#a3y ;oto tora PA (25*10*201/) +e!an 6ron7iti! non !e!i=%
e% 6 o!t tran!9&!i
LNTARA 2 "@EST:E +AMAR / (EML 0852,,,2,,1/) 2. Bed 1 Ro6in ood
5-10-1,,. .401,1 MRS /-12-201/ "r !a$&e3 SB +B"
"* Tra&$a t&$&3 a6do$en
La6 /-12-1/ @"S1/ r*r 22*0? @T*@PT 10*5 Na*+*3 1/1*4?2*101 T*BT C/0* /G PT*APTT 14?1* 2/? B 8?,. RB 4?84 HB 1/?8 HT /8?, PLT 422
:;" Na3 28 t$ e9triaone 1#r*12* Ranitidin 1 a$*8 ' Awa!i tanda a%&t a6do$en dan T:
2 Bed 2 di /1-12-1,54 ./425 MRS 2,-11- 201/ "rdr6rai$ L SB +B"
"* T& ae7&$
T !7an tora (25-11-1/) Meta!ta!i! t& %e ar& den#an 3y$adenoaty eri6ron7ia3 -%3a!i=%a!i +@B !&67arina T !7an a6do$en (20-10-1/) Ma!!a 7ae7&$ den#an tanda i3e&! o6!t ;oto tora%! 20-11-1/ Tanda $eta %e ar&
RL 20 t$ Ranitidin 50 $#*8'*i +etoro3a7 /0 $#*8 ' "iet 6e6a! T&n##& a!i3 S@ a dan ro 7o3on in 3oo
28 Bed 4 Pranoto /1*12*1,.5 ./.85. MRS 1/*11*201/ "r dr 6rai$ La6eda? SB- +B!e$en
"* PH 2 3aaroto$i e7 $e#ae!o9a#& !
La6 /0-11-1/ B 2.?0/ RB5 H6 11?8 HT/.?. PLT 4.0 E7o7ardio#ray - di!9&n#!i !i!to3i% L: 6ai%? E; .8< - di!9&n#!i dia!to3i% La6 12*11*201 B 12?, RB 4?48 HB ,?, HT /0?1 PLT 48 @"S 88 r 14 r 0?8 S@T 22 S@PT 12 Na 1/. + 4?4 3 104 T 8C00 BT /C00 APTT 2?.(22?2) PT 14?1(11?8) H6!A# non rea%ti9 e!oa#&! (/0-10-201/) Me#ae!o9a#&! den#an =33in# de9e7t
e9triaone 1 #r*12 -%etoro3a7 /0 $# * -PT /500 Ranitidine 50$#*8 ' Ren7ana o %a$i! 5*12*1/ +on!&3 erioerati9
14
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 ada !i!i %anan ( aa%a !&at& $a!!a ata& $a!!a den#an 6eJoar) Hernia!i #a!ter di!ertai tanda-tanda &3%&! #a!ter a%&t den#an !&! Ma!!a di daera 9&nd&! ;oto tora PA*AP (12*11*201/) !o9t ti!!&e $a!! den#an 6eJoar dida3a$nya (!&! Me#a e!oa#&!) MST :ete6ra Tora%a3 S3idin# ernia Me#ae!o9a#&!
2, Bed / Fo!e Mowend& 22-0,01,4 MRS 4*12*1/ RM .//2.2 "rdr Rona3d SB+B"
Pro %e$oterai !i%3&! 2
LNTARA 2 Beda "i#e!ti9 +AMAR 10 (i!wanto 085254/2525) /0 BE" 1 Ny Hadia
1*10*1,.0 K 5/ ta&n MRS 18-11- 201/ RM ./8001 FAM+ES"A
+i!ta Me!enteri&$
La6 2-11-201/ B 4?/ RB /?04 H@B ? HT 24?8 PLT 21. S@ A6d 2.-11-201/ Ma!!a $e!enteri&$ 6er!eta3 di!ertai a!7ite! o3e3it La6 2/-11-201/ B 4?,0 RB /?/5 H@B 8?. HT 2.?4 PLT /4, La6 21-11-201/ RB 2?2. H@B .?/ HT 20?4 PLT 2.8 B 5?0 La6 20-11-201/ RB 1?,. H@B 4?/ HT /4? PLT 2.0 B 4?/ La6 18-11-201/ B 4?/. RB 1?4. H@B 2?. HT 10?/ PLT 21/ T*BT 8C*/C PT*APTT 12?5*21?, @"S 120 r*r 18*0? @T*@PT 1*, Na*+*3 140*4?0*11/ PA /-10-201/ airan +i!ta Me!ote3 Pro3i9erati9 den#an inIa$a!i (airan Peritoni&$) +i!ta He$ora#i% (airan +i!ta)
Parade ren7ana oe e9triaone 1 #r*12'*i Ranitidin 50 $#* 8'a +etoro3a7 /0 $#*8 'a "iet 6e6a!
/1 Bed 2 H' Fia P*80 ta&n MRS /0-11-2-1/ RM ./,4,
PH draina!e T&$or adne%!a Mei# Sindro$
La6 t#3 2-12-201/ RB 4?,0 H@B 1/?5 HT 42?1 PLT 250 La6 /0-11-201/ S@PT 45 rotein tota3 5?/ a36&$in /?1 #3o6&3in 2?2 Na*+*3 1/.*4?0*112 T S7an t#3 2,-11-201/ Ma!!a %o$3e%! adne%!a E9&!i 3e&ra 6i3atera3 La6 tan##a3 28-11-201/ T 8?00 BT /?00 PT 12?, APTT 2 @"S 25 r 21 r 0?, S@T 1.8 rine R&tin 28-11-201/ arna +&nin# a#a% %er&? rotein /*Q/00 #3&%o!a 2*250 63ood
:;" RL " 5 < 11 1 t$ Ranitidine 1 a$*8'*ii +etoro3a7 / #*8'*iD e9triaone * 12'a$*i
15
/2 Bed / Na'e P*44ta&n*/-- 1,.,
2.-10-201/ RM ./4/./ F+" "r6rai$ La6eda?SB(+) B"
T&$or re7ti 1*/ di!ta3 t&$a$a (S) !&! Pi3oide!
La6 (2.*11*201/) B 1?18 RB/?., H@B 10?. HT 2,?, PLT 52. 6i3ir&6in tot 0?5 S@T 21 S@PT
La6 (2.*11*201/) A36 2?4 B 1?5 RB /?1. H@B 8?, HT 2?4 PLT 410
La6 (2/*11*201/) B 1.? RB 2?.1 H@B ?4 HT 22?1 PLT 280 @"S 128 &r*7r 1/*0?4 S@T*S@PT 1/*, rot tot /?4 A36 1?, Na*+*3 1/4*2?*108
La6 (21*11*201/) @"S 8 Prot tot /?8 A36 1?, B 1,?, RB /?/5 H@B ,?/ HT 2.? PLT 158
La6 18*11*201/ PT*APTT 11?*/0?, NR 1?00 Na*+*3 1/5*2?.5*10, @"S 11 &r*7r 10*0?4 A36&$in 1?, S@T*S@PT /4*15 Protein Tota3 /?1 @3o6&3in 1?2 La6 18*11*201/ B 2/?81 RB 2?/. H@B .?/ HT 18?. PLT /2. La6 1/*11*201/ ;e$itin ,5?41 PT*APTT 1/?5*/1?0 NR 1?12 Na*+*3 12,*4?5*101 A36&$in 2?5 %o3e!tero3 tota3 210 %o3e!tero3 H"L 20 %o3e!tero3 L"L 14/ tri#3e!erida 21, 7a3!i&$ ?/ $a#ne!i&$ 1?. ;e(6e!i) 2 TB 1/. @"S 85 &r*7r 11*/?, S@T*S@PT 1*8 Protein Tota3 8?1 La6 1/*11*201/ B 14?,5 RB /?1. H@B 8?/ HT 24?4 PLT /,, La6 /1*10*201/ Protein tota3 .?1 A36&$in 2?2 Na*+*3 1/.*/?5*10 La6 /1*10*201/ B ?5 RB 4?14 H@B 10?1 HT /1?0 PLT /,1 La6 2.*10*201/ B 1044? RB /0? H@B 8/? HT 20? PLT 4/2 S@ A6d 2.*10*201/ +e!an Ma!!a ron##a e3Di! !e!&ai &nt&% $a!!a re7to!i#$oid ;oto Tora 2.*10*201/ -S&! T& $eta!ta!i!%e ar& dd* ne&$onia &3$o detra -3e&ra rea7tion detra T !7an a6d 2*10*201/ -Ma!!a re7to!i#$oid yan# $en#in=3tra!i &ter&!
:;" a$inoI&id Na RL Pan A$in @ 11 iroIoa7in 200 $#*8'*iD Ranitidine a$*8'*iD 7airan Di A36&$in /2 diet 6e6a! $o6i3i!a!i a%ti9
1.
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 -nod&3 !o3iter ar& %anan !&! t&$or $eta!ta!i!
// Bed 4 Hadaria*P*2 tn*1--1,8. ./510/ MRS /1*10*201/
Fa$%e!$a!
T&$or a6do$en !&! Li$9o$a $a3i#na
La6 t#3 /*12*01/ Na 122 + 2?.? 3 ,?5 La6 t#3 /0*11*01/ RB 4?41 H@B 12?0 HT /.?1 PLT 4, M: 8/ MH 2?/ La6 2.-11-201/ @"S 52 r*r 40*0?2 @T*@PT 2*2 Na*+*3 12.*/?5*111 T*BT 8C00G*/C00G PT*APTT 14?,*21?8 B ?2 RB /?/8 H@B 8?. HT 2.?2 PLT /. La6 24-11-201/ B 1// RB /. H@B ,81 HT 2,, PLT 2 r*r 2,*08 @T*@PT /0*40 ProtTot 5, A36 24 Na*+*3 1/2*28*108 +o3 Tot 12, La6 18*11*1/ B 5?4 RB 5?02 H@B 1/?0 HT /?. PLT 2/. @"S ,4 r*r /*0? @T*@PT 22.*.8 Na*+*3 124*/?0*81 La6 15*11*1/ B 4?4 RB 4?4 H@B 11?, HT /4?0 PLT 420 @"S 0 r*r 25*0? S@T*S@PT 2,*1/ T*BT 8C*/C PT*APTT 1/?4*24?. NR 1?11 Na*+*3 11,*2?4*. La6 5*11*201/ Na*+*3 1/*2?5*8 La6 1*11*201/ @"S 1 re&$ 28 +reatinin0?4 Bi3ir&6in tota3 0?28 Protein tota3 4?/ A36&$in 2?4 @3o6&3in 1?, Na 1// + /?8 3 100 B 12?54 RB 2?88 H@B ?0 PLT 5.0 La6 /1*10*201/ B 8?8 RB 5?1. H@B 1/?4 HT /8?, PLT 4// @"S 8. R*R /0*0?, @T*@PT 50*20 NA*+*L 12.*2?/*1? T*BT 8C00G*/C00G PT*APTT 11?0*2.?,? Protein tota3 ?5 a36 4?2 S@ A6do$en /1*10*201/ Ma!!a araarrtae !&! Li$9o$a Hydrone9ro!i!detra T A6do$en ( /1*10*201/) %e!an $a!!a intraa6do$ina3 !&#e!ti9 3i$9o$a $a3i#na ydrone9ro!i! %anan a!7ite! ;oto Tora or dan &3$o nor$a3 Tida% ta$a% tanda-tanda $eta!ta!i! ada 9oto tora ini
n!tr&%!i o!t oera!i :;" RL Na3 0?, < 20 t$ e9triaone * 12'a$*i Ranitidine 1 a$*8'*ii +etoro3a7 / #*8'*iD Awa!i TT: e% 6io!y ato3o#i anato$i
/4 Bed 5 Ny Sitti M&rni 01*12*1,52
T&$or A6do$en
La6 t#3 28-11-201/ B 5?, R67 /?.1 H#6 ,? H7t 2,5
e% dara 3en#%a +on!&3 erioerati9
1
SABTU, 7 DESEMBER 2013 RM ./,/4 P3t /25
t*Bt 8C00*/C00 PT*APTT 11*21?. @"S 105 S@T*S@PT /1*18 Na*+*3 1/*4?.*102 r 42 r 1?4. a36&$in /?8 H6! A@ Non rea%ti9? EA 2?04
iroIoa7in 2500 A!a$ $e9ena$at / $# Ranitidin /1
/5 Bed . R&!ain A$ad 20-12-1,85 RM ./.,8, MRS 22-11- 201/
PH 1 e%!3ora!i B" e7 o3e3itia!i!
La6 t#3 2-12-201/ B ,?0. R67 4?81 H#6 1/?4 H7t /,. P3t //4 t*Bt 8C00*/C00 PT*APTT 1/.*2.?5 S@T*S@PT 120*1/5 Na*+*3 1/.*/4*104 r 15 r 0?., 2.-11-201/ Bat& di!ta3 B" di!ertai %o3e!tati% intra-e%!traeati% dan di!ten!i @B o3e3it 25-11-201/ a 1,-, 18?.1 T-S7an o3e A6do$en 12-11-201/ o3e!tati7 intra dan e%!tra eati7 !a$ai B" e7 6at& ada an#%a3 B" o3e3it S&! Mio$a teri
La6 12-11-201/ 67 / R67 /?,/ H#6 10?, H7t /11 P3t /2, t*Bt 8C00*/C00 PT*APTT 1/4*25 S@T*S@PT 181*/48 Na*+*3 140*/8*10. +o3 Tota3 2.4 H"L 45 L"L 1,.1 TB 11, A36&$in /8 Bi3 "ire% 5?2 a3%a3i 9o!9ata!e 50.
S@ A6do$en 12-11-201/ o3e!tati% e7 !&! 6at& B"
:;" RLNa3 0?, < 5< 111 28 t$ n' e9triaone 1*1 n' MetronidaJo3e #r*8'*iD n' Ranitidine 1 a$*8'*iD n'%etoro3a7 1 a$*8'*iD Bo3e $in&$ Ta%ar rod&%!i drai T t&6e*24 'a$ Ba3an7e 7airan
LNTARA 2 +AMAR 11 (Mo "i$a! !$ai3) /. Bed 1 Tn F&aren#
1**1,.1 .405// MRS 4*11*201/ F+M "ri6rai$ 3a6eda? SB +B"
PH . draina#e a67e!! !7rot&$
La6 4*12*201/ B 1?,1 RB 4?05 HB 11?2 PLT 4/, rottota3 4?1 A36 1?, @3o6&3in 1?, T*BT C/0*/C00 r*r 22*0?. @T*@PT 24*21 Na*+*3 1/1*/?.*10 @"S 110
:;" RL 28 t$ e9triaon 1 #r*12'a +etoro3a7 1 a$*8'a Ranitidine 1 a$*8'a MetronodaJo3e 0?5 #r*8'a$*iD +&3t&r &!
/ Bed 2 S&'iono* L*./ ta&n 01*0*1,50 (./1/2) MRS 0.*11*201/ Pena#ian
"* PH . 3aarato$i e%!3ora!i
2*12*201/ A36&$in/?4
2.*11*201/ B 10?2 ? H@B 11?4 ? PLT .1,? RB /?,2
20*11*201/
iroIoa7in 500 $# /1 Para7eta$o3 500 $# Ranitidin ta6 /1 "iet !&!&
18
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 "r dr Rona3d E L? SB-+B"
T 8? BT /? PT 1/?4? NR 1?11 APTT //?2 Na 1/0 + /?.? 3 10/ H6!A# non rea7tiDe Anti H: non rea7tiDe? @"S 80? r 2 r 0?,? @T 5.? @PT /2? A36&$in 2?5 La6 12*11*201/ B /? RB /?51 H@B 10?4 HT 2,?4 PLT /05 Na 1/4 + /?8 3 105 @"S 84 r*r 15*0?8 S@T*S@PT 20*5 Protein tota3 .?2 A36 2?, A!rat .?4 T 8C BT/C PT*APTT12?8*2.?4 La6 *10*201/ B 5?. RB /?,0 HB 10?, HT /2?. PLT /, T 8C00G BT /C00G PT 11?0 APTT 2?. EA 1?01 @"S ,0 &r 21 7r 0?, @T 21 @PT . Na*+*3 1/1*/?,*108 +o3ono!%oi 1*10*201/ Ma!!a t&$or etra3&$iner in=3trati9 ro%titi! dera'at !edan# Bio!i 21*10*201/ Eite3 den#an di!3a!ia rin#an dan radan# %roni% a%ti9 S@ A6do$en (0,*10*201/) +e!an $a!!a etra3&$iner den#an e$6e!aran +@B Di33i &!&! o3on n3oo (0,*10*201/) +e!an T&$or re7to!i#$oid den#an tanda-tanda o6!tr&%!i in=3trati9 T-S7an A6do$en (0,*10*201/) +e!an Ma!!a re7to!i#$oid yan# in=3tra!i %e 'arin#an di !e%itarnya ("+ES )
;oto Tora R P&3$o da3a$ 6ata! nor$a3 3d ;ra7t&re 1*/ $edia3 o! 73aDi7&3a detra
/8 Bed / M& Tair*L*/2 tn 1,*12*1,80 (.2214.) MRS1,*,*201/ Fa$%e!$a!
"PFP "rdr6rai$ La6eda?SB- +B"
"*PH 20 Laarato$i E3ora!i 3eo!to$i
;oto 3&$6o!a7ra3 2*11*201/ +e!an tida% ta$a% %e3ainan ada 9oto 3&$6o!a7ra3 ini n7identa3 =nd ta$a% di3ata!i 3oo- 3oo &!&! den#an #a$6aran earin# 6one La6 2*12*201/ B 4?,0 RB /?.4 #610? PLT 14 La6 2/*11*201/
r*7r /1*1?1? @T*@PT 44*45? A36 /?0 ? Na*+*3 140*/?8*10,? RB 4?22? HB 12?1? HT /.?,? PLT 401? B 5?
La6 1,*11*201/ Bi3 tota3 0?,4? Bi3 dire7% 0?2? @T 1/?
Mo6i3i!a!i d&d&% "iet 6e6a! T+TP e9adroi3 2500 $# LeDoIoa7in /500 A!a$ $e9ena$at / $# Ranitidine 2 150 $# :P A36&$in /2 ta6
1,
KORAN BEDAH DIGESTIF
A36&$in /?1? Na*+*3 1/2*/?.*101? HB!A# non rea7tiDe? anti H: (-)? B .? RB /?./? H6 10?.? H: 8,? PLT /1, rin R&tin 22*10*201/ arna %&nin#? H ?Prot(-)? #3&%o!a nor$a3? &ro6i3ino#en (-)? 63ood (-)? 3e&%o!it (-) La6 11*10*201/ 67 .?. RB /?,1 H6 11?. PLT /,, A36 /?4 La6 1*10*201/ @"S 124 R 11 r 0?. @T 1 @PT 1/ Prot tt3 .?1 a36 2?, T 8 BT / PT 1/?0 APTT 25?, Na 1/ + 4?4 3 108 B ?0 RB 2?/ HB ?1 PLT /15 La61,*,*201/ RB /?/4 B 14?. H#B 10?1 HT /0?/ PLT 2, @T*@PT /4*2 A362?1 Na*%*3 1/5*/?,*108 H6SA# (-) T*BT 8?00*/?00 PT*APTT 1/?4712?4*/1?5 7 24@"S ,/ r*r 10*0?8 La6 21*0,*201/ A36&$in 2?.0? ;oto tora%! (2.*,*1/) E9&!i 3e&ra %anan ;i!t&3o#ray (1*10*1/) ;i!te3 entero7&tane&! S@ a6do$en 2.*,*201/ E9&!i 3e&ra %anan
/, Bed 4 Ha!'&n La%i-3a%i RM .//8/. T#33air 1-.- 1,0 // tn MRS 2/*10*201/ FAM+ESMAS
"r dr 6rai$ La6eda? SB- +B"
PH . 3aarato$i e%!3ora!i $i3e!C ro7ed&re
La6 2*12*201/ @"S ,/ r*r 21*0? @T*@PT 18*12 Na*+*3 1/5*/?*10. HB!A# non rea7tiDe B .?1 RB4?2, HB 12?8 PLT 250 La6 18*11*201/ B 15?,1 RB 4?15 H@B 12?4 HT /4?5 PLT 4// La6 1.*11*201/ re&$ 1/ %reatinin 0?5 @T*@PT 1,*1 Prottota3 4?, A36&$in 2?, @3o6&3in 2?0 Na*+*3 1/2*/?*,8 T*BT 8G*2C/0G PT*APTT 10?,*2?0 @"S 11.
@anti o6at ora3 e9adroy3 500 $# 2 Ranitidin /1 A!a$ $e9ena$at 50 $# /1
20
KORAN BEDAH DIGESTIF
Adeno7ar7ino$a dieren!ia!i !edan# La6 2/*10*201/ B ?0/?RB>4?/5 HB12? HT /.?0 PLT>42/ T>C00 BT> 2C/0 PT>,? APTT2.?2 @"S,. R> 1 R> 0?5 Na> 1/, %> /?. 73>100 HB!A# non rea7tiDe? anti H: non rea7tiDe ;oto tora PA*AP 2/*10*201/ +P detra a%ti9 Tida% ta$a% tanda-tanda $eta!ta!i! ada 9oto tora ini
40 Bed 5 Tn M&a$ir 1*1*1,5, ./88, 22*11*201/ F+"
PH 18 3aarato$i e%!3ora!i e7 er9ora!i #a!ter
La6 24*11*201/ r*7r /,*0?8 ? B 1,?2 ? RB /?58? HB ,?2 ? PLT /5
;oto tora 24*11*201/ +e!an !&! E9&!i 3e&ra " "i3atation et e3on#ation aortae La6 2/*11*201/
HB 1/?00 ? M: , ? MH 25?1 ? MH /1?8 ? PLT /4? B 2.?? HB!A# non rea7tiDe ? @"S 1//? @T*@PT 1//*
:;" RL Na3 11 e9triaone 1#r*8'a PantoraJo3e 40 $#*24'a$*iD Mo6i3i!a!i 'a3an "iet 6&6&r 6ia!a T+T LeDoIoa7in 1 #r*12' MetronidaJo3e 500 $#*8'a$ +&3t&r anti6ioti%
41 BE" . M&!tari d# n#an%a Tt3 18*.*.. ./08.1 Mr! 2,*10*1/ F%$ "r dr 6rai$ La6eda?SB- +B"
PH 1 3aarato$i e%!3ora!i re!e%!i i3e&$ 3ea%a#e ana!to$o!i! i3e&$ ter$ina3 i3eo!to$i
2/*11*201/ B 1.?/ RB 4?2 H@B 11?5 HT /4?1 PLT .8 T*BT 8*2?/ PT*APTT 1?4*//?1 Na*+*3 1/*/?1*112 22*11*201/ @"S .4 &*7r 21*0?, @T*@PT 2.*5 Prot Tota3 /?, A36&$in 1?, Na*+*3 1//*/?1*110 H6!A# (T) Non rea%ti9Anti H: Non Rea%ti9
1*10*201/ (9oto o3o! A6do$en) Tida% ta$a% %e3ainan radio3o#i7 ada 9oto o3o! a6do$en ini
*10*201/(o3on-n3oo) Ma!!a 7o3on tran!Der!&$ !i!i %anan !&!e% $a3i#nan7y
LeDoIoa7in 500 $# Para7eta$o3 500 $#
21
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 1*10*201/ ;oto Tora PA or dan P&3$o nor$a3 Tida% ta$a% tanda-tanda $eta!ta!i! ada 9oto tora ini
2*10*201/ (T A6do$en Ata!*Bawa) Ma!!a $e!enteri&$ re#ion %anan a6do$en
1*10*201/ (S@ A6do$en) Ma!!a intra3&$inar re#ion 3&$6a3 %anan 3e&ra %anan
LNTARA 2 N+L@ (Mo "i$a! !$ai3*081/42//45.)
LNTARA 2 RL@ ( Mo "i$a! !$ai3*081/42//45.) 42 +a$ar
11 6ed 1
oana P*5-,-1,.1 (52tn) RM ./5,1 MRS 14*11*201/ F+M
o3e!i!to3it ia!i! HT @r
La6 .*11*201/ B ?2 RB 4?81 H@B 14?1 HT 42?. PLT 2,0 @"S 142 r*r /1*0?, @T*@PT /,*21 A!&rat .? TBT 8C00G*/C00G NR 1?02 Na 142 + /?, 3 110 H6!A# (-) Anti H: (-) S@ *11*201/ +e!an ne9ro3it (S)? 7o3e3it La6 2*12*1/ T*BT 8*/? PT*APTT 12?? 28?4 NR 1?0.? @"S ,,? r*r 22*1?04? S@T*S@PT 2/*2/? Na 14/? + /?,? 3 112? B 8?8.? RB 4?.0? H@B 1/?8? HT /,?/? PLT 285
era!i ari ini
Tn Sain 10*.*1,.1 RM ./4/0/
PH /4 3aarato$i e%!3ora!i 7o3edo'e'&n o!to$i #a!troyeyeno !to$i
;oto 3&$6o!a7ra3 AP 3atera3 4*12*201/ +e!an tanda-tanda $&!73e !a!$?!ondi3o!i! 3&$6a3i! rin#an?o!teooro!i! !eni3i! ;oto tora%! AP3atera3 4*12*1/ +e!an !ondi3o!i! tora%a3i!?o!teooro!i! !eni3i! La6 1,*11*201/ B 15?, RB /?42 H@B 10?1 HT 28?2 PLT 22/ r*r 14*0?5 @T*@PT 40*/0 TT PRT .?/ ALB 2? Na*+*3 1/,*2?4.?10/ @"S 120 La6 10*11*201/ B 15?/1 RB /?. H@B 10? HT 28?/ PLT 202 PT*APTT 10?8*/8 Na*+*3 1/.*2?4/*10/ @"S 12. BL TTAL 8?1/ BL "RE+ 5?,0 @T*@PT /2*55 ALB 2?4 La6 8*11*201/ B 1.?. RB /?18 H@B ,?5 HT 28?4 PLT 114 @"S ,1 r*r 10*0?5 BL TTAL 10?1 BL "RE+ ,?2 @T*@PT ,?2*.1
"iet 6e6a! T+TP :;" RL"5 28 t$ Ranitidine 1 a$*8'*i +etoro3a7 1 a$*8'*iD e9triaone 1 #r*12'*i :P A36&$in / 4 ta6 HP ro /1 +on!&3 orto? rawat !a$a
LNTARA 2 RTHPE" ( Mo "i$a! !$ai3*081/42//45.) LNTARA / MATA (Mo "i$a! !$ai3*081/42//45.nto 085254/2525)
44 +a$ar 2 6ed 2
A Ha!yi$ Se!!& 22-0.-1,4, RM ./,/.
PH . HL (S) ireoni6i3i!
;oto tora 0/*12*201/ ardio$e#a3i di!ertai di3atation et atero!73ero!i! aortae
:;" RL"511 28 t$ n'e%!i ranitidine 1
22
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 MRS 2,*11*201/ E7o7ardio#rai 28 -11-201/
"i!9&n#!i dia!to3i7 L: L:H E; 4 <? AR $oderate Ha!i3 La6 28-11-21/ B .?/ RB 4?2, H@B 1/?/ HT 41?2 PLT 22 T*BT 8C00G*/C00G @"S 1/1 r*r 4, * 1?2 @T*@PT 2*/5 PT*APTT 10?,*25?/ Na*+*3 1/,*4?4*10
a$*8'*iD n'e%!i 7e9triaone 1#r*12'*iD n'e%!i %etoro3a7 1 a$*8'a$*iD Bo3e $in&$ Bo3e $a%an 'i%a tida $&nta Ren7ana &3an# ari
45 +a$ar 1 6ed
2
Na$a Ro!$iati ae /2 Ta&n Medi! ./,2/8 MRS 4-12- 201/
7o3e3itia!i! La6 t#3 0/*12*1/ S@T 2/S@PT 44 #a$$a 1.. La6 t#3 28*11*1/ Bi3ir&6in tota3 1?1.? 6i3dire7t 0?4? a3% o!ata!e ,.?a36&$in 4?1? &r*7r 11*0?,?Na*+*3 1/*4?0*101 La6 tan##a3 2.*11*1/ B 5?4 RB 4?., H@B 14?1 HT 40?8 PLT /48 T*BT 8C00G*/C00G @T*@PT /.8*/22 S@ t#3 2.*11*1/ +o3e!tati% intra dan e%!tra eati% e7 6at& B" ?o3e3it T S7an t#3 28*11*1/ o3e!tati7 intra dan e%!traeati7 e7 6at& di!ta3 B" ne&$o6i3ia o3e3it den#an 7o3e7y!titi!
Pro oera!i ari ra6&
LNTARA / BE"AH THT ( Mo "i$a! !$ai3*081/42//45.)
LNTARA / SARA; ( Mo "i$a! !$ai3*081/42//45.) 4. L1 BB
%1 B/ Ada$ T'aar ! RM 444 582 /1-12-1,45 +on!&3 dr Sara9
-He$oroid intern #r : -He$oroid eterna -He$iare!e (") Tyi7a e7 HS
PT1/?2 APP20/ @"S,8 r2/ %r11 S@T 25 S@PT1/ +o3e!tero3 Tota3 12 H"L 4, L"L105 Tri#3i!erida0, 7%40 %-M610 Troonin T0?02 Na1/. %/?8 +3114
Ardi&$ 2-2-2 ti$a3i!a!i +
LNTARA / +L-+EL ( Mo "i$a! !$ai3*081/42//45.)
LNTARA 4 @NE+L@ (He3en 08525//24/04 dan ;ir$an 08525/.05408) 48 +a$ar 4
Bed 4 Po3iati P*01-02- 1,./(50 ta&n) RM ./2,1 MRS 0*11*201/ Fa$%e!$a!
Po!t o draina!e a!7ite!
+o3e3itia!i! +i!ta ear +i!ta Me!enteri&$ PH . draina#e a!ite!
02*12*201/ A36&$in 2?0 2,*11*201/ B ?2, RB /?. H@B ,?0 HT 28?. PLT /,2 24*11*201/ A36&$in ?0 B ?2, RB /?. H@B ,?0 HT 28?. PLT /,2 La6 15*11*201/ B 5?,2 RB /?24 H@B ? HT 24?1 PLT 41/ T*BT 8C00*/C00 r*r 22*0?, @T*@PT 2/*14 A36&$in 2?2 La6 2/*10*201/ A125 /581,, T A6do$en
@: er ari Sto in9&!e A n9&! e9adroi3 2500$# Ranitidine /1 A!a$ $e9ena$at / A %ateter
2/
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 Ma!!a oDari&$ %iri +i!ta Me!enteri&$ +i!ta ear o3e3it A!ite! E9&!i 3e&ra detra La6 1*10*201/ B 5?4 RB 4?. HB 10?, PLT 55 Na 141 + /?, 3 10, @"S 111 r 21 r 1?0 @T 1, @PT . A36 /?/ T 8 BT / PT 12?4 APTT // S@ A6do$en 18*10*201/ Ma!!a %o$3e%! oDari&$ %iri +i!ta ear o3e3it A!ite! dan e9&!i 3e&ra %anan
4, +a$ar . Bed 4
Sa3i$a /1*12*1,.4 RM ./5258 MRS 1*11*1/
N+ Ma3i#na E9&!i 3e&r 6i3atera3 A!7ite!
P draina!e a!7ite! H-20
La6 28*11*201/ A36&$in 2?2 La6 2.*11*201/ B 1/?5/ RB 4?1. H@B 11?5 HT /2? PLT 55 La6 11*11*201/ A36&$in 1,0 La6 5*11*201/ B 14 RB 4/4 H@B 125 HT /51 PLT 4.1 r*r 8/*1?5 @T*@PT 28*1 Na 1/. + 41 3 105 La6 1*11*201/ B 8?8 RB 4?.. H@B 1/?2 HT /?2 PLT 40, HB!A# non rea7tiDe A! &rat .?/ r*+r .0*1?/ S@T*S@PT /4*1/ A36 /?/
Terai !e!&ai TS BT+ Ta%ar rod&%!i 7airan*ari
50 +a$ar 5 6ed 2
;at$a Sin'ai 10*10*1,5/ MRS /0*11*201/ ./,8./
A!ite! T& Adne%!a
La6 05*12*201/ B 10?.. RB /?84 H@B 11 HT /2?8PLT /1. La6 01*12*1/ T*BT *2 PT 11?2*10?8 APTT /0?2*25 @"S 104 r*r 84*0?, @T*@PT 42*11 B 12?24 RB 2?8. PLT 4?/ H@B ? HT 2/? MST 2*11*201/ +e!an $a!a %o$3e%! adne%!a? a!ite!
(He3en 08525//24/04 dan ;ir$an 08525/.05408) 50 Lt 2
%a$ar 11 B1
Ny H' St Sya$!ia 5,,1,. *.*1,55 (58tn) AS+ES MRS 14*11*201/
T&$or re%ti 1*/ ro%!i$a3 ? !&! $a3i#nan7y
La6 25*11*201/ o3on in 3oo +e!an !&!e% t&$or re7to!i#$oid La6 18*11*201/ EA 1?/0 ALB 2?8 La6 14*11*201/ @T*@PT /2*1, ALB 2?8 Na*+*3 1/5*/?22*101 B .?. RB 4?22 HT /?/ PLT /,8 H@B 12?4 PT*APTT 12?.*22?, NR 1?0 @"S 21. r*r 1/*0?5 T*BT 8C00G*2C00G T S7an A6do$en (12*4*201/) +e!an tida% ta$a% $eta!ta!i! ada T !7an a6do$en ini
"iet T+TP Mo6i3i!a!i d&d&% Terai !e!&ai TS nter Bi3a nyeri +etoro3a7 $# *8'a$ *iD Ranitidin 50$#* 8'a$
24
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 Endo!%oi (28*/*201/) +e!i$&3an e$orroid eterna? e$orroid interna #r ? T& Re7ti !&! Ma3i#na S@ (20*11*201/) +e!an T& $eta!ta!e ear? e9&!i 3e&ra 6i3atera3 (NA"A 0821,/,82200)
25
5/ Lt/ /14
Ny Marta Tt3 2.*5*1,45 R$ 5814/0 Mr! 1*12*201/ "i%on!&3t#3 4*12*201/
"r dr ar!in##i? SB-+B"
aLida Pro #a!tro!to$y 9eedin#
La6 5*12*201/ 67 /.8 r67 282 #6 8. 7t 25. 3t /4/ La6 2*12*201/ @d! 1, !#ot*!#t 25*10 Na*+*3 1/8*4*100 &r*7r 1*0/,
Per6ai%i + Terai3an'&t TS 6edaon%o3o#idanintern
54 Lt4 %40.
"r dr Rona3d E L&!i%ooy SB-+B"
HL (") Reoni6i3iti!
La6 /*12*201/ 67 , r67 440 #6 12. 7t /.8 3t 40 BT /00 T 00 PT 1// APTT 2/ #d! 11, &r*7r /.*102 a!&rat .5 #ot*#t 1,*18 ;oto tora a /*12*201/ nor$a3
D9d RL 28 t$ Sta6iine 1 #r*12' ;arnat 0?5 #r*8' ;arain a$*8'
RSU (ANA 081341804!)
55 RSH 408
N&raeni Mr! 2*12*201/ R$ 0155,8 Tt3 20**1,8
Po 1 e$oroide%t o$i
3a6 28*11*201/ w67 ,4/ r67 482 #6 128 3t 24 7t /81 #d! ,5 &r*7r 5*05 6t*7t /C*8C
D9dr3 24tt!*$nt e9triaone 1 #r*12*iD Ranitidine a$*8'*r +etoro3a7 a$*8'*r NoIa$i7yn!yr 21 Ardi&$ /1 Laadyn !yr 21 Min&$ 6e6a! Awa!i%&ttD
5. RSH 424
"e6ora Sa3indin# RM 01.0.4 2,*12*1,.4 (4, ta&n) MRS 20*11*201/ AS+ES
dr Main7ara? S B K +B"
Po / 3aaroto$y aende7to $y
;oto o3on in Loo t#3 28*11*201/ Tanda-tandaeradan#an aendi den#anro7to7o3iti! La6 20*11*201/ B 4?/2 RB /?.5 H@B ?/ HT 25?4 PLT /,, Na*+*3 141*/?.*105 T*BT */ PT*APTT 1.?5*/1?0 S@T*S@PT 14*5 @"S 11/ r*r 28*0?8 HB!A# ne#atiDe Anti-H: ne#atiDe S@ A6do$en 1,*11*201/ +e!an Aendi7iti!
raDit 21 Ranitidine 21 Oy#aDit 11 @Da#i*!ore Teraiinterna3an'&t
5 RSH 41. A
"arwi! Ma7$&d /1*12*1,58 RM 010/. MRS 12*11*201/ di%on!&3t#3 14*11*201/ AS+ES
"r dr ar!in##i? S B K +B"
A67e!! 3&$6a3detr a Po!t 3aaroto$y aende7to $y
La6 /0*11*201/ @d! 10, La6 2*11*201/ B5?42? RB /?5. H@B 10?. HT /1?. PLT 252 A36&$in /?/ @"P 10. Ha!i3%&3t&r &! 14*11*201/ LeDoIoa7ine !en!itiDe La6 12*11*201/ B .?4 RB /?24 H@B ,?8 HT 2,?/ PLT 24 S@T*S@PT 8*8 r*r /5*1?0 A36&$in /? La6 4*12*201/ @d! 1/.
raDit 21 Ranitidine 21 Oy#aDit 11 @D a#i*!ore "iet 6ia!a Mo6i3i!a!i 'a3an
2.
Be d4
Ny "a$ari! Pa!a A!%e! ./.,48 12*10*1,5/ Pere$&an MRS 2*11*1/
Po!t 3aaroto$y e%!3ora!i e7 er9ora!i %or&! #a!ter t& @a!ter 'e'&no!to$ y 9eedin# PH
Ana3i!a #a! dara 05*11*201/ PH // 2 .0?/ S2 80? 2 48?8 H/ /2?2 7t2 14?4 BE 5?/ A@" 04*12*201/ H ?50? S02 ,,?1? 2 4.?5? H/ 11,?.? H/ /.?. 7t02 1.?8? BE 2?. La6 04*12*201/ Na*+*3 14,*/14*1// T*BT 8C/0*/C00 PT*APTT1.?2*/2? NR 1?/4 @"S 158 S@T*S@PT 50*/. B .?4 RB 4?1, H@B 11?2 HT /4?2 PLT 10, %e!an a3%a3o!i! $eta6o3i7 ter%o$en!a!i !e$&rna ;oto tora 04*12*201/
- ETT den#an &!&! di!ta3 ada $ain 6ron7&! %anan
- ardio$e#a3y di!ertai ede$a &3$o
- or&! a3ine&$ (e3&r&) ada e$itora %anan
-
La6 1*12*201/ B ?4 RB 4?20 HB 11?2 HT /5?1 PLT 50 r*r 8,*1? @T*@PT 4*4/ Na*+*3 1/* /? *118 Ana3i!a #a! dara 1*12*201/ PH 2. 2 5? S2 ,08 2 .? H/ 2.?2 7t2 15?. BE -1?0 La6 /0*11*201/ B ,?24 RB 4?14 HB 11?. HT /4?4 PLT .4 T*BT 8C00*2C/0 PT 1.?5 7ontro3 12?5 NR 1?/ APTT 4/?4 7ontro3 24?5 @"S // r *r 8.*1? A36 2?/ Na 145 + 4?0, 3 11. ;oto tora AP 1*12*201/ Ede$a &3$o d#n e9&!i 3e&ra 6i3atera3 or&! a3ine&$ (e3&r&) !etin##i araDerte6ra : T
;oto tora AP 28*11*201/ +P d&33e 3a$a a%ti9 or&! a3ine&$ (e3&r&) !etin##i araDerte6ra : T
;oto o3o! AB" / o!i!i 28*11*201/ Tanda Ktanda o6!tr&%!i &!&! a3&! dan er3en#%etan "i!tended #a!ter
Ana3i!a #a! dara 2,*11*201/ PH 25 P7o2 /8. S2 5,?, P2 /84? H/ 14 7t2 1., 7t2 18/ BE -85
"rdrRona3d L&!i%ooy?SB -+B"
He$orroid int #rade :
La6 2,*11*201/ 67 8?, r67 4?/0 6 12?4 7t /?8 3t /.0 $a3aria $i%ro!iti% (-) La6 /*12*201/ Sedi$en &rine eritro!it 0-1 Le&%o!it 0-/ Eite3 2-/
Terai3an'&tdrinterna "iet 3&na% ardi&$ /1
5, /15 A#&n# M&a$$ad Mr! 28*11*201/ 10*11*1,, R$ 01/82,
"rdrRona3d L&!i%ooy?SB -+B"
Po . aende7to $y
La6 28*11*201/ Pt 1,?8 att //?5 w67 15?2/ r67 5?50 6 15?/ 7t 44?2 3t /25
A in9&! Mo6i3i!a!i 'a3an @D !e6e3&$ &3an# e9adroy3 2500 A! Me9ena$at /500$ "iet 3&na% Bo3e &3an#
.0 RSH 424
Debora Salinding RM 01.0.4 2,*12*1,.4 (4, ta&n) MRS 20*11*201/ AS+ES
dr Main7ara? S B K +B"
Po 2 3aaroto$y aende7to $y
;oto o3on in Loo t#3 28*11*201/ Tanda-tandaeradan#an aendi den#anro7to7o3iti! La6 20*11*201/ B 4?/2 RB /?.5 H@B ?/ HT 25?4 PLT /,, Na*+*3 141*/?.*105 T*BT */ PT*APTT 1.?5*/1?0 S@T*S@PT 14*5 @"S 11/ r*r 28*0?8 HB!A# ne#atiDe Anti-H: ne#atiDe S@ A6do$en 1,*11*201/ +e!an Aendi7iti!
Terai 3an'&t A %ateter Mo6i3i!a!i d&d&% "iet 6&6&r !arin#
.1 RSH 42.
Dr! dr! Ronald E! "# S$!%&K%D
HL (") re%&ren!
lab 5/12/201 w67 .,1 r67 5.4 #6 12 7t 502 3t /0, Na*+*3 140*/,*101 S@T*S@PT /.*54 a36&$in 4. @"S 181 &r*7r 25*1/ 'o(o ()ora* $a 5/12/201 Tida%ta$a%%e3ainan radio3o#i7 E+)o 6/12/1 "i!9&n#!i dia!to3i7 L:? L:H? E; .5<
Ren7anaoera!iari!a6t *12*201/ 000 P&a!a 8 'a$ !63$oera! Pi%&3 5 a#i$a!&%%and&37o3a o!taria 1
.2 /0. tn A$ad $r! 22*11*201/ di%on!&3t#3 /0*11*201/ 1*12*1,5, R$ 01.14/
"rdrRona3d L&!i%ooy?SB -+B"
He$orroid int #rade :
"ab 29/11/201 67 8?, r67 4?/0 6 12?4 7t /?8 3t /.0 $a3aria $i%ro!iti% (-) "ab /12/201 Sedi$en &rine eritro!it 0-1 Le&%o!it 0-/ Eite3 2-/
Terai3an'&tdrinterna "iet 3&na% ardi&$ /1
R"
2
No Bed dentita! "ia#no!i! Pe$eri%!aan Pen&n'an# Terai 1 B1*
+, Ny "arna TL 2.- 02-1,55 MRS 18*11*201/ RM .205/
AS+ES
E7o7ardio#ra$ .*12*201/ +e!i$&3an
- "i!9&n#!i dia!to3i% L: - E; .8< ;oto tora 02*11*201/
- "i3atatio aortae - E9&!i 3e&raa !ini!tra - P3ate 3i%e ate3e%ta!i! ar& %anan MR a6do$en 22*11*201/ +e!an - Tida% ta$a% %o3e!tati% intra dan
e%!tra eati% - Bat& d&7t&! 7y!ti7&! di!ertai
7o3e7y!titi! - Heato$e#a3y - n7identa3 =ndin# 9ra%t&r
%o$re!i : T 10-11 ;oto tora 20*11*201/ +e!an - P&3$o nor$a3 - ardio$e#a3y di!ertai di3atatio aortae
La6 1,*11*201/ H6A17> 5?2? a3%a3i 9o!9ata!e ,54? @a$$a @T 0? Na*+*3 145*4?*10,? PT 1/?0 7ontro3 12?.? APTT 2,?4 7ontro3 24?4? NR 1?08
La6 12*11*201/ RB 4?5. H@B 12?5 HT /?0? PLT /./ B ,?0 @"S 1/? @2PP 1/2? &r*7r 1/*0?,0 A!&rat /?5 Bi3tot 5?21? 6i3dire% /?/ @T /85? @PT /44
T a6do$en 12*11*201/ @a33!tone o3e7y!titi! Heato$e#a3i
- @: ari ini - n' 7e9triaon 1
#r* 12'* : - Ranitidin ta6
- "iet rend 3e$a%
2 B2* +4*2
Ny Sa33a$a /1*12*1,.. 4. Ta&n ./.81, MRS 12*11*201/ +NSL 14*11*1/ A!%e! a'i6
"rdr 6rai$ La6eda? SB +B"
Adeno7ar!in o$a o3on A!7enden! Re!idi9
La6 /*12*201/ @3o6&3in /?? @"S 250? r*r 11*0?5,? S@T*S@PT 28*2.? Prottota3 .?1? A36&$in 2?4? T*BT ,C00*4C00 PT 15?4 7ontro3 12?4? NR 1?24? APTT 25?0 7ontro3 24?0? Na*+*3 124*/?,*, La6 02*12*201/ B 1/?? RB /?45? H6 ,?/ HT 2?0 PLT ./2? @"S 250? r*r 11*0?5,? S@T*S@PT 28*2.? Prottota3 .?1? a36&$in 2?4? #3o6&3in /?? PT*APTT 15?0*25?0? NR 1?24? T*BT ,?00*4?00 Na*+*3
1 "iet 6e6a! !&!& eti!o3 / 250 77
2 n'e%!i !oo6ion 1 a$*12 '* dri!
/ ti$a3i!a!i +
1
SABTU, 7 DESEMBER 2013 124*/?,*,?
La6 /0**11*201/ B 15?45? RB 4?1? H6 10?.? HT /1?4 PLT 5,8? Na*+*3 1/1*/?.*11/ La6 2*11*1/ @"S 150? Na*+*3 128*4?0*104 La6 2.*11*1/ B 1/?4? RB /?8 H6 ,?8? HT 2,?4 PLT 525 La6 22*11 *1/ B 1.?2 H@B ?8 RB /?1/ HT 24?8 PLT .?58 (Ane$ia $i%ro!iti% io%ro$? tro$6o!ito!i!?3e&%o!ito!i!) o3on n Loo 21*11*201/ Tida% ta$a%7o3on a!7enden! dan 1*/ roi$a3 7o3on tran!Der!&$ La6 1,*11*1/ B,?5?H@B11?0?HT/0?.?PLT55/ La6 18*11*1/ EA 1?8? A 1,-, ,?,, La6 1.*11*1/ B14?/?H@B,?11?HT2??PLT5 0 Ha!i3 PA 10*0.*1/ Adeno7ar!ino$a 7o3on ? $oderate3& dierentiated den#an %ed&a &'&n# re!e%!i 6e6a! t&$or ;oto tora%! PA 1/*11*1/ Tida% ta$a% tanda tanda $eta!ta!i! ada 9oto tora% ini MST !7an a6do$en 1/*11*1/ Ma!!a 7o3on a!7endena! den#an tanda tanda o6!tr&%!i &!&! di roi$a3nya Heato!eno$e#a3i? tida% ta$a% tanda tanda $eta!ta!i! %e ear La6 1/*11*1/ Na*+*3 1/5*4?2*108? Bi3ir&6in tota3 0?1? Bi3ir&6in dire% 0?1? A3%a3i 9o!9ata!e .,? @a$$a @T 18
/ B2*.* 2
ASKES
T&n##& a!i3 3a6 - La6 3en#%a - ;oto tora
(!enin)
4 B2* +8*1
S&ardin 1*0*1,.0 5/ Ta&n .//,51 MRS 2/*10*201/ +NSL 1*11*1/ A!%e!
PH 24 Laarto$i e%!3ora!i e$i7o3e7to $i (") draina!e a6e! i3e&$ ter$ina3a6
La6 2*12*201/ +&3t&r Sen!iti9 A$i%a7in? 3ora$9eni7o3? ;o!9o$i7in? @enta$i7in? Meroene$ La6 2.* 11* 201/ @T /2? @PT ,? A36&$in 2?5 La6 15*11*1/ A36&$in 2? B /8?0/ RB 2?,, H@B ,?1
- @: d#n wo&ndre!!
- "iet tin##i rotein
e! ear a6!e! erine9ri%
"M tie 2
den#an &ndierentiated 3eo$or=% !ar7o$a La6 14*11*1/ r*r 22*0?/ @T*@PT 11*, Na*+*3 1/2*4?/*10/ PT 14?2 7ontro3 11?2 NR 1?08 APTT 2?2 7ontro3 2/?2 La6 PA 1/*11*1/ - Ma3i#nant ;i6roi!tio7yto$a (T&$or n#&ina3) - A67e!! (Farin#an Boto3) La6 11*11*1/ @"S 1/2 @T*@PT 48*1/ A36&$in 2?4 T*BT 8C00CC*/C00CC PT 1?5 7ontro3 12?4 NR 1?44 La6 08*11*1/ @"S 1, r*r 10*0?. @T*@PT 11*. Protein Tota3 5?8 A36&$in 2?0 T*BT 8CC00C* /G00C H6 8?1 B 4/?/ RB 2?,4 PLT //. PT 1,?, 7ontro3 11?4 NR 1?./ APTT 40?. 7ontro3 2.?2 Na*+*3 1//*4?/*, La6 .*11*201/ B /1 RB 22, H@B .2 HT 1 PLT /.0 @"P //8 @"2PP 121 La6 2/*10*201/ @"S 15 r*r 1*05 S@T*S@PT 1*20 Na*+*3 12.*4/*,, T*BT 8*/ PT*APTT 14,*/08 HB!A# Rea7tiDe Anti H: non rea7tiDe La6 24*10*201/ EA 10. T !7an a6d tana den#an %ontra! /1*10*201/ - Hidrone9ro!i! dan !oa! a6!e!
%anan - +i!ta ear di!ertai
eato$e#a3y S@ te!ti! 28*10*201/ Hydro7e3e detra S@ a6d 2/*10*201/ Ma!!a intraa6do$ina3 !i!i %anan di!ertai e3Do7a3ye7ta!i! detra Tora PA 2/*10*201/ - or dan &3$o nor$a3 - 3d 9ra7t&re 1*/ ten#a 73aDi7&3a
%anan? 7o!ta -: %anan 6e3a%an# dan 7o!ta :-: %iri 6e3a%an#
/
5 B2* +, B1
ST M&nawarra (.0 tn) RM ./ -,.-8 TL /1*12*1,52 MRS 2,*11*201/ +on!&3 /0*11*201/ AS+ES
"rdr6rai$ La6eda SB +B"
S&! Aendi7iti! %roni% o6!erDa!i ari %e 8
La6 04*12*201/ A$y3a!e an7reati7 /5? Lia!e 50 La6 /*12*201/ @"P ? @"2PP 1, La6 01*12*1/
+o3tota3 440? +o3H"L 2,? tri#3i!erida 11, S@ A6do$en /0*11*201/ +e!an #a$6aran aa%&t d#n aendi7o3it
La6 2,*11*1/ B 11?48? RB 4?00? H612?4? HT /4?,? PLT /11?? @"S ,,? r*r 25*0?? S@T*S@PT 20*21? Prottota3 .?8? a36&$in 4?4? #3o6&3in 2?4? Na*+*L 1/,*/?8*11.
rin r&tin 2,*11*1/ arna %&nin# $&da? P .?0? B' 1?105? rot?(-)? #3&%o!A (-)? 6i3ir&6in (-)? %eton (-)? nitrit (-)? B3ood *10? 3e%o!it (-)? !ed$en 3e%o!it 0-1? eritro!it 0-2? !edi$en %ri!ta3 0-2
- T S7an A6do$en - Nor$a3 Dia %o$&ter
- Ren7ana 3aora!%oi 6i3a a!ien !et&'& ari ra6& t#3 11*12*201/
. B2*10 B2
A$ri (4. tn) RM 54 4 . TL 15*/*1,. MRS 05*12*201/
AS+ES
Hernia in#&ina3i! (S) reoni6i3i!
La6 2,*11*201/ B ,?2? RB 4?.? H6 14?0? HT 40?5? PLT 425? T*BT 8C00*/C00? PT 12?, 7ontro3 12?5? NR 1?0? APTT 2?5 7ontro3 2?4? Na*+*3 142*4?/*10,? @"S 8? r*r 2.*1?54? a!a$ &rat 8?5? S@T*S@PT 25*42? H6!A# dan anti H: (-)
;oto tora 2,*11*201/ Tida% ta$a% %e3ainan radio3o#i% ada 9oto tora ini
S@ a6do$en 18*11*201/ +e!an - S3&d#e @B - S3eno$e#a3y
- Ren7ana 'adwa3 oera!i Ra6& 11*12*201/
- +on!&3 re&$ato3o#y? a!$ &rat (8?5)
PALEM BAAH (Rita Herawany 085-242-551-105)
B2*1 Bed 2
Tn"ira$ RM .2 24 8 TL 0*0/*1,45 MRS 28*11*201/ +on!&3 2,*11*201/
AS+ES
E9&!i 3e&ra (") H; e7 A"
La6 5*12*201/ @"S 112? r*r 41*1?15? S@T*S@PT /1*1? +o3tota3 ,,? +o3H"L dire7t 10? +o3L"L dire7t 4/? Tri#3i!erida 1.? TSH ?.,? ;T4 1?/8 La6 4*12*201/ B ,?4? RB 4?.0? H6 12?5? HT /8?2? PLT ..0 S@ 2,*11*201/ +e!an "i3ata!i 3oo-3oo &!&! d#n eri!ta3ti7
- da rawat !a$a TS endo%rin $eta6o3i%
- "iet 6&6&r - T&n##& 'awa6an
7o3ono!7oy - :i a36&$in /2
7a! - ti$a3i!a!i +
"i!tendid @B den#an !3&d#e di da3a$nya
+i!ta #in'a3 %iri E9&!i 3e&ra !ini!tra Tida% ta$a% 7airan 6e6a! 7aD&$ eritone&$
/5?? PLT 58? PT 18?, 7ontro3 10?0 NR 1?5.? APTT /.? 7ontro3 24?0 @"S 1,0? R*r ..*1?2? S@T*S@PT 2.*1,? Prottota3 .?2.? a36&$in 2?0? #3o6&3in /?5.? a!a$ &rat ,?. ? Na*+*3 1/0*/?.*114
8 B2* +5*1
M&7tar Ta$6i Tan##a3 3air /1-5-1,48 RM ./8.. Tan##a3 $a!&% 28-11-201/
A!%e!
"rdr 6rai$ La6eda? SB (+B")
%ter&! o6!tr&%!i e7 !&! !tenoti7 B" ""* t& a&t an%rea!
La6 /*12*201/ B ?20? RB /?1? H6 12?? HT /4?2? PLT /1,? T*BT 8C00*2C00? PT 12?1 NR 1?01? APTT /0?0? @"S 81? R*r /,*1?1/ Bi3tota3 18?4.? 6i3dire7t 1.?40? S@T*S@PT 4,*42? a3%a3i 9o!9at 2,? @a$$a @T 52? Prottota3 5?8? a36&$in 2?,? Na*+*3 1//*4?.*10/? HBSA# (-)? anti H: (-) MR 2.-11-201/ Ha!i3 - Steno!i! B" di!ertai %o3e!tati%
intra-etraeati7 dan di!ten!i @B - o3e7y!titi!
La6 2.-11-201/ a 1,-, 2//?22?
La6 25-11-201/ PT 11?5 7ontro3 12?5? APTT 28?8 7ontro3 2?1
La6 20-11-201/ @3&%o!a to3eran!i 8,*1,0 HBA17 4?/ A3%a3i 9o!9ata!e /.2 @a$$a@T 124
La6 18-11-201/ @"S 12? &r 4.? r 1?2? 6i3tot ,?. Bi3dire% .? @T 5.? @PT 0 T 8C00 BT 2C00 PT 15?2 APTT /0?0 NR 1?2. Natri&$ 1/? +a3i&$ 4? 3orida 104? B ,?82? RB /.? H@B 1/?0 HT /4?? PLT 41.
T !7an a6do$en (tana %ontra!) 1,- 11-201/ Ha!i3 7o3e!tati7 intra dan e%!traeati7 e7 !&! 3&!7ent !tone! ada di!ta3 B" (""*Steno!i! B")
- :i a36&$in /2 - +on!&3 erioerati9 oti$a3 &nt&% oera!i
- Fawa6an HM oti$a3 &nt&% di3a%&%ana oera!i
- Ren7ana oera!i ari %a$i! 12-12- 201/
5
SABTU, 7 DESEMBER 2013 , B2*
+8*2 Ninin# 18*01*1,4 /, Ta&n MRS 22*10*1/ +NSL 2*11*201/ AS+ES
"r dr 6rai$ La6eda? S B- +B"
PH /. Mi3eC! Pro7ed&re e7 a re7ti 1*/ di!ta3
Ha!i3 MR (22-11-201/)
3eDe3
"e9e7t ada 3inea $ediana (6e%a! oera!i) anterior De!i7a &rinaria
Tida% ta$a% =!te3 dari re7t&$ %e
Da#ina $a&&n :e!i7a &rinaria Ha!i3 PA (08*11*1/) Adeno7ar!ino$a $&!ino!&$ dieren!ia!i 6ai% den#an 1 &'&n# re!e%!i $a!i $en#and&n# t&$or /1*10*1/ B /2?5. RB /?/ H@B 10?2 PLT /22 22*10*1/ T*BT 8*/ PT 11?5 7ontro3 10?5 NR 1?00 APTT 24?8 7ontro3 25? Na*+*3 145*/?.*110 S@ (22*10*1/) Ma!!a re7t&$ Tida% ta$a%tanda tanda $eta!ta!i! ada S@ !&3 MST-S7an A6do$en den#an %ontra! ;oto tora%! (22*10*1/) Tida% ada tanda tanda $eta!ta!e ada 9oto tora%! ini La6 22*10*1/ r*r 40*0?, @"S 188 @T*@PT 1.*8 Prottota3 5?/, A36&$in 4?23 T A6do$en (22*10*1/) +e!an $a!!a di!ta3 re!e!&ai d&%! A
- iroIoa7in 2500 $#
- "&ro#e!i7 at7 12?5 $#
- Mo6i3i!a!i 'a3an - T&n##& a!i3 %&3t&r
10 B1* "anie3 Pa%o6on# T#3 3air 15*08*1,5. (5) MRS 25*11*1/ MR ./.550
AS+ES
"rdr Rona3d L?SB-+B"
PH 10 3aaroto$y dan !i#$oide%to $i e7 adeno 7a !i#$oid
La6 28*11*201/ B 22?4/? RB 4?./? H6 14?1? HT /8?,? PLT /15 La6 2* 11* 201/ B ?? RB 4?1,? H@B 12?,? HT /8?/? PLT 2,,? PT 1/?2 (7ontro3 10?8)? APTT /1?4 (7ontro3 24?0)? @"S ./? &r*7r 28*1?0/? @T*@PT 2/*2/ La6orat&ri&$ 25-11-201/ E3e%tro3it? Na 1/.? + /?,? 3 111 MST !7an A6do$en Ma!!a retro!i#$oid (d&%e! A) Ha!i3 PA 1,*11*1/ Adeno7ar!ino$a retro!i#$oid La6 11*11*201/ B ?4 RB 4?25 H@B 14?4 HT 41?2 PLT /20 @"S 11,? &r*7r /4*0?8 @T 22 @PT 2/ EA 0?., PT 12?5 (7 12?4) APTT 28?. (7 22?) S@ 11*11*201/ - Tida% ta$a% tanda-tanda
$eta!ta!i! ada S@ a6do$en ini Hiertro= ro!tat
- :;" RL 28 TPM - n' 7e9triaone 1
#r*12'*D - n' antoJo3 40
$#*12 'a$*iD - Min&$ 6e6a! - "iet 6&6&r
!arin# - S&!& eti!o3
/250 77 - Mo6i3i!a!i 'a3an
+10* B2
$i ani $&#ni T#3 3air 11*12*1,4 RM ./ 82 Tan##a3 $a!&% 25-11-201/
A!%e!
PH 4 e%!3ora!i B"
La6 02*12*201/ T*BT 8?00*/?00? PT 11?,? NR 0?,,? APTT 25?0 La6 25-11-201/ ;t4 1?8,? TSH! 1?54? T 8C0G? BT /C00G? PT 1?. 7ontro3 11?8 NR 1?45? APTT /1?5 7ontro3 2?
La6 18*11*201/ B 8?. H@B 1/?8? RB 4?5,? HT /8?? PLT /00 A36&$in /?, +o3 tota3 2/5? H"L ?/? L"L 140? T# .14? @"S 11 Na 1/? + /?,? 3 101 r*7r 1/*0?8 Bi3 tot 21?8/ Bi3 dire% 18?54? @T 45 @PT //
- :;" RL 28 t$ - iroIoa7in 1
%o39*12 'a$*iD - Ranitidin a$*8 'a$*iD
- +etoro3a7*8'a$*i D
- Ta%ar rod T K T&6e drain *12 'a$
- Ma%an dan $in&$ 6ia!a
- Mo6i3i!a!i d&d&%
12 B2/ K14/B1
Ny.Atika Usman (61 tahun) RM 63 80 34 MRS 1/11/13 21/04/1!2 K"nsu# 26/11/2013
ASK$S
%kt&'us "st'ukti &.* +u.*a,ut ,an*'&as
a 04/12/2013 B !3 RB 36 10! + 313 + 168 +/B+ 8500/2530 + 13 (103) %NR 11! A++ 30 (21) Na/K/# 13/24/10 7S 113 U'/' 10/064 Bi#.t"ta# 206 Bi#.i'&*t 181 S9+/S+ 48/1. '"t.t"ta# 60 a#umin 2! a 01/12/2013 B 18 RB 340 100 + 16 + 26 +/B+ 800/200 + 12! *"nt'"# 100 %NR 100 A++ 3!0 *"nt'"# 2!0 Na/K/# 138/2/114 7S 132 U'/' 14/06 Bi#.t"ta# 14 Bi#.i'&*t 1!6 S9+/S+ 63/21 ,'"t.t"ta# 63 a#umin 22
a 2!/11/2013 + 136 *"nt'"# 12! A++ 314 *"nt'"# 21 %NR 113 a#umin 24
MR% A"m&n 2!/11/2013 St&n"sis ista# B7 is&'tai k"#&statik int'a- &kst'ah&,atik an ist&nsi B
US A"m&n 22/11/2013 K&san - h"#&statik int'a an &kst'ah&,atik is&'tai
ist&n& B - A*it&s a 20/11/2013 B 3 RB 303 86 + 2!2 + 2!4 Bi#.t"ta# 16 Bi#.i'&*t 1644 A#ka#i "satas& 21 amma + 234 $A 246. A 1- 14463 ama'an 7a'ah +&,i K&san An&mia n"'m"sitik n"'m"k'"m sus,.kausa an&mia ,&nyakit k'"nik is&'tai #&uk"sit &n:an tana-tana in&ksi.
a 1/11/2013 B 1060 RB 326 0 + 240 + 244 +/B+ 830/330 + 62! *"nt'"# 10 %NR 4 A++ !4 *"nt'"# 230 7S 8! U'/' 11/0! S9+/S+ 6/2! ,'"t.t"ta# !8 a#umin 1 Na/K/# 13/23/10 BsA: (-) anti ; (-)
+ A"m&n 1/11/2013 K&san h"#&statik int'a an &ksta'ah&,atik &* sus,. St&n"sis ista# B7 77/ am,u##a <at&'i
="t" th"'a> 1/11/2013 K&san - ,u#m" a#am atas n"'ma#
-%n?.;it K 1 am,/%M - K"nsu# ,&'i",&'ati &#um ",tima# -
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 - *a'i"m&:a#y &n:an i#atati"n &t &#"n:ati"n a"'ta&
LNTARA (aty 082-/4,-0-101 ) 12 L1 AB
+$r
3e&! o6!tr&%ti9 artia3 -A!7ite! -i%ter&! Tro$6o!itoen ia
01*12*201/ ;oto a6do$en / o!i!i -!e!&ai #a$6aran i3e&! o6!tr&%ti9 3eta% tin##i (SB) -!&!A!7ite! ;oto Tora PA*AP -E9&!i 3e&ra detra BN / o!i!i -Air ;3&id 3eDe3 () -"i!tri6&!i &dara "i!a3&ran() $en&r&n
-Hier6i3ir&6ine$ia -enin#%atan EnJi$ Tran!a$ina!e
Bi3ir&6in tota3 ,?4 Bi3ir&6in "ire% 5?. @T 84 @PT PLT .1000 PT 2/?2 APTT 44?4 NR 1?84 Na1/2 +/?, 3115 A36&$in 2?4 H6!A# ()
67 5?/ R67 /?/0 H@B11?4 HT/1?, MH/4?5 MH/5?
1/ L1BB +5 %e3a! 6ed /
Nyi!a TLn/1*12*1, RM ./44 MRS 15*11*201/ F+M "i%on!&3 dari interna tan##a3 /*12*201/
"* o3e3itia!i!
12?0 HT/.?2 PLT/55
La6 24*11*201/
S@ wo3e a6do$en 21*11*201/
+e!an 7o3e3it? idrone9ro&reter %anan
+i!ta #in'a3 %iri
S&! retero3it detra
La6 0/*12*201/ 67 .?0 H6 12?0 PLT /55 r // r0?80
Saat ini a!ien $a!i 6er&ndin# &nt&% di3a%&%an tinda%an 7o3e!i!te7to$ y
14 L1A" +5 Bed 2
N&r aini RM ./ 8, 20 TL /0*12*1,.0 F+" MRS 25*11*201/ %on!&3 4*12*201/
%ter&! o6!tr&%ti9 e7 !&!6at& B"
MRP (d#n %ontra!) /*12*201/
- Ma!neter d 7o3e!eo an%rea!
- Steno!i! &'&n# di!ta3 B" di!ertai
%o3e!tati% intra-e%!tra eati7 dan
di!ten!i @B
a6do$en ini
- Laor traineer 6eda di#e!ti9
8
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 B 10?/.? RB7 4?8/? 6 1/?/? HT
/,?,? PLT /85? @"P ,0? @"2PP ,4
a3%a3i 9o!9at ./0? @a$$a @T ,82?
%o3tota3 245? %o3H"L 25? +o3 L"L 144?
T@ 15,? PT *APTT 12?2*2?0? NR 1?02?
Anti H: (non rea%ti9)? H6!A# (-)
r*r 1*0?8? Bi3tota3 4?/? Bi3dire7t
/?52? S@T*S@PT 18*18,? Na*%*L
1/,*/?2*112 15 L1 AB
%/**B .
Ha$%a P 02-02-1,52 .1 Ta&n ./852, +on!&3 interna 05*12*201/ FAM+ES"A
T& 1*/ re7t&$ di!ta3 re7t&$ d#n $eta!ta!i! %e ear ("&%e! " ) !3eno$e#a3i
T o3e a6do$en ("en#an %ontra!)
- T& 1*/ re7t&$ di!ta3 re7t&$ d#n
$eta!ta!i! %e ear ("&%e! " )
!3eno$e#a3i
HT/0?5
PLT2/.
S@PT14 A36&$in 2?. TB-141
-
Mar#ono 11-0/-1, .405/1 +on!&3 interna 0.*12*201/
+" !t# 5 e7 Ne9roati HT on AP" Hioa36&$ine $ia (/?0)
04-12-201/
@3o6&3in2?5 @"S,5 r105 HB4?1
PLT188 &r1.5 7r12?4
-
LNTARA 2 "@EST:E +AMAR 1 RMA (0852422484.8
1 Bed 1
FAM+ESMAS
PH 1/ 3aaroto$i e3ora!i e7 7o3e!i!to'e'& no!to$i Bra&n ana!to$o!i!
La6 5*12*201/
HT22?5 PLT41/ PT*APTT 12?1*2.?8
T*BT 8C00*/C00 @T*@PT 124*41
NR 1?01 6i3tota3 ?/5 6i3dire% 5?,8
#d! 112 Na*+*3 1/4*/?/*10/ r*r
2.*0?50 a3%a3i o!at 188
La6 28*11*201/
@T*@PT 11*2, ? a3%a3i o!at
22/? @a$$a @T 1
7t*6t C00*2C/0 t*at 11?0*/0?1 inr
0?,2 6i3 tot 2/?/ 6i3 dire% 24?8 #ot*#t
.8*18 a36 /?1 w67 /?44 r67 4?22 6
12?, D7t /5?4 3t 4//
E7o (18*11*201/)
+e!an
- di!9&n#!i ddia!to3i%
La6 1/*11*1/
PT 12?/ APTT /5?/
,
+L TTAL 252 +L H"L ?4 +L
L"L 1// TR@LSER"A .14
La6 8*11*1/
;S;ATASE 215 @AMMA @T 48
La6 *11*1/
/4?0? PLT /,4 H6!A# (-)? anti H:
(-)?@"S 1/2? &r*7r 1/*0?8? Bi3 Tot
20?/? 6i3dire7t 21?.1 S@T*S@PT
21*4? rottot 4?8? a36/?0? #3o6&3in
1?8? PT*APTT 24?8*41?,?
;T THRA *11*201/
+e!an
!&! Se!i=%
et e3on#a!i aortae
S@ A6d 11*11*201/
+e!an
eati%
(11*11*201/)
eati% e7 S&! $a!!a 7a&t
an%rea!
- Hyertroy ro!tat
18 Bed 2 Tn "#Nai 14*12*1,58 ./4,48 28*11*201/ F+M "rar!in##i? SB +B"
A* e$ato$a !7rot&$ o!t erniora=
La6(28*11*201/)
@"S 8 r*r 1.*0?. ? @T*@PT /5*.1? Na*+*3 1/*4?4?*11? RB 41.*HB 12?1? HT /?? PLT ///? B 10?1
RLNa3 10001000 t$ +etoro3a7 1 a$*8'a Ranitidine 1 a$*8'a "iet 6ia!a NonIa$in /1 e9triaon 1 #r*12'a MetronidaJo3e 0?5 #r*8'a$*iD
10
SABTU, 7 DESEMBER 2013 Bed / &n&! Oa#oto
1,*12*1, .40.8. 5*12*201/ $&$ "rdr6rai$ La6eda?SB- +B"
Periaendi7 &3ar in=3trat
La6 5*1*2201/ B 15?4 RB5?/2 H@B1.?/ PLT /10 T 8C00G BT /C00C PT*APTT 10?4*2?8
S@ a6do$en 5*12*201/ +e!an !3i#t eato$e#a3y den#an 9atty 3iDer tanda-tanda eriaendi7&3ar in=3trat
:;" RL 28 t$ e9triaon 1#r*12'a$ Ranitidine a$*8'a$* MetronidaJo3e 0?5 #r*8'a$*iD
SLAS (RSMA 082/48204048) 20 !o
Bed 2
Tn o3e "# Baa L*01-0-1,5.*./ tn ./81 MRS 1,-11-201/ F+M "rdr 6rai$ 3a6eda? SB- +B"
S !e!a% + !edan# A6do$en !&e3? eri!ta3ti7 ()? 3&%a oera!i %erin#? BAB ()? BA+ 3an7ar
A PH 1. Laaroto$i e%!3ora!i eritoniti! #enera3i!ata e7 er9ora!i #a!ter
La6 21-11-201/ B 8?1 RB 4?15 H@B ,?0 HT 2,?, PLT 2.0 La6 20-11-201/ B 1.?, RB 4?2 H@B 8? HT 28?, PLT /04 La6 1,-11-201/ B 1,? RB 4?28 H@B 8?8 HT /0?0 PLT /10 @T*@PT 24*1/? Prottot .?/ A36 2?, Na*+*3 140*4?2.*111 HB!A#*AntiH: (-) S@T*S@PT 24*1/ rotein tota3 .?/ a36 2?, Na*+*3 140*4?2.*111 H6SA# non rea7tiDe Anti H: non rea7ti7e T*BT ,*/ PT*APTT 1/?1*//?, @"S 115 &r*7r 42*0? S@ A6do$en (1,*11*201/) +e!an airan 6e6a! intraeritone&$
RL 5001 e9triaone 1#r*12'*iD San$o3 1#r*8'*iD MetronidaJo3e 500$#* Ranitidin 1a$*8'*iD Bi!o3Don 1a$*8'*iD :i a36&$in /2 ta6 Terai !e!&ai t! BT+: n9&! +L 1 I7 da3a$ N 0,< 50077 n9 A36&$in 20< 1 6t3*
21 !o Bed
1
Tn P&t& Adnyana L*2,-12-1,,*2/ tn /588,4 MRS 2,*11*201/ F+M
S - + 6ai% A6do$en !&e3? eri!ta3ti7 () !to$a 6ai% rod 9e!e! () A o!t 7o3o!to$y
La6 12-11-201/ B 5?8 RB 4?8 H@B 15?. HT 42? PLT 220 @"S ,5 r 15 r 1?0 @T 1/ @PT 10 Na 1/, + /?8 3 102 T 8C00 BT /C00 Pt 1/?, APTT 2.?, HB!A# (-)
Pe$eri%!aan Loo#ra= (1/-11- 201/) Po3o! A6do$en "i!tri6&!i &!&! !a$ai %e di!ta3 den#a 9e7a3 $ateria3 yan# !an#at 6anya% Tida% ta$a% di3ata!i 3oo-3oo &!&!? #a$6aran errin# 6one +ed&a !oa! 3ine inta% +ed&a re eritonea3 9at 3ine inta% T&3an#-t&3an# inta% ;oto 3oo#ra= +ontra! 6ari&$ !e6anya% 100 77 di$a!&%%an $e3a3&i %ateter %e da3a$ !to$a? tana taanan $en#i!i 7o3on de!7enden? 7o3on tranDer!&$? ta$a% &3a $en#i!i
Pro 7o3o!to$y 73o!&re
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 $7o3on !i#$oid? re7t&$ %e$&dian %e3&ar $e3a3&i an&! M&%o!a 7o3on re#&3ar? 7a3i6er 3&$en dan a&!tra!i 6ai%? tida% ta$a% =33in# de9e7t $a&&n additiona3 !adow ;oto 7o3on in 3oo +ontra! 6ari&$ !e6anya% 100 77 di$a!&%%an %e da3a$ %ateter $e3a3&i an&!? ta$a% $en#i!i re7t&$? 7o3on !i#$oid? !e6a#ian 7ontra! %e3&ar $e3a3&i !to$a!e6a#ian $a!&% $en#i!i %o3on M&%o!a 7o3on re#&3ar? %ai6er 3&$en dan a&!tra!i 6ai%? tida% ta$a% =33in# de9e7t $a&&n additiona3 !adow
T !7an A6do$en (11-11-201/) "e9e% dindin# anterior a6do$en re#ion 3&$6a3i! %iri r#an-or#an intraa6do$en yan# ter!7an da3a$ 6ata! nor$a3
;oto Tora PA (11-11-201/) Tida% ta$a% %e3ainan radio3o#i ada 9oto tora ini
LNTARA 2 "@EST:E +AMAR 2 (EML 0852,,,2,,1/) 22 Bed 1 Si$on ;i33a
L*18-08-1,8 RM ./5082 MRS /1-10- 201/ F+M %on!&3 interna 12*11*201/ "r dr Rona3d? SB +B"
PH / 3aaroto$i e%!3ora!i RS "F !tent de%!tra e7 T& o3on A!7enden !&! $a3i#nan7y idrone9ro!i! detra
La6 25*11*201/ B /?5 RB /?, H@B 10?5 HT /1?5 PLT 4.4 T*BT 8*/ PT*APTT 14?1*/0?8 @"S 85 r*r /1*0?8 @T*@PT 52*5 Prot Tot .? A36 2?, La6 18*11*201/ B 8?., RB /?,? H6 10? HT/2?1 PLT 501 #ot*#t .*51 &r*7r /2*0?, La6 14*11*201/ B 8?24 RB /?/8? H6 ,?.? HT 28?5 PLT /,. ;e 0? Bi3 Tot 0?./? 6i3dire7t 0?4. S@T*S@PT 5*50 NR 1?0 a3%a3i 9o!9ata!e 8., a36 2?. #a$$a #t /4? rottot 7t*6t 8C00*/C00 PT*APTT 12?*20?8 o3on in 3oo 15*11*201/ +e!an t&$or 7o3on a!7enden! !a$ai Ie&ra eati7a
Endo!%oi (11*11*201/) +e!an He$orroid interna #rade T& 7o3on a!7enden! !&! $a3i#nan7y MST o3e a6do$en (non %ontra!) (01*11*201/) +e!an S&! $a!! ada 7ae7&$ in##a
RL Na3 "5 111 2 t$ Ranitidine 1a$*8'*iD +etoro3a7 1 a$* 8'*i e9triaone 1 #r*12 ' Ranitidine 1 a$*8' MetronidaJo3e 1 a$3*8'a$*iD
12
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 Ie&ra eati! 7o3on a!7enden!? den#an e$adatan $&n#%in !&at& er3en#%etan den#an 3oo-3oo &!&! di!e%itarnya Hydronero!i! detra ;oto Tora PA 01*11*201/ +e!an tida% ta$a% ro!e! $eta!ta!i! ada 9oto tora ini
2/ Bed 2 Tn wan 1--1,/ ./8/,5 MRS 20*11*201/ "rdr Rona3d SB +B"
T&$or Sa7ro7oy#e a3
La6 28*11*1/ B ,?21 RB 4?1/ HB 11?2 HT //?. PLT 28 A36 /?8
T a6do$en 21-11-1/ - Ma!!a !a7r&$ yan#
$ende%!tr&%!i o! !a7r&$ dan $e3&a! %e ron##a e3Di! !&#e!ti9 7ordo$a
- Hidrone9ro!i! di!ertai idro&reter 6i3atera3
;oto o3on in3oo 2-11-1/ o3on in3oo da3a$ 6ata! nor$a3? %e7&a3i ene%anan 6a#ian re7to!i#$oid o3e $a!!a
La6 20*11*201/ B 11?44 RB /?20 H@B 8?2 HT 24?, PLT /04 @"S 11, r*r 44*2?40 @T*@PT 28*11 Prot Tot .?0 A36 /?0 +o3 Tot 214 +o3 H"L // +o3 L"L 150 T@L 114 Na*+*3 145*/?,*108 S@ A6d 20*11*201/ Ma!!a %o$3e%! ron##a a6do$en yan# $enye6a6%an indenta!i dindin# o!terior 6&3i-6&3i dan ydrone9ro!i! 6i3atera3
-Ranitidine 2 150 $# B7o$ 21 T#& 'adwa3 o
24 Bed / B&di$an .-12- 1,81 ./,424 MRS 2*11*201/ F+" "r Sa$&e3 SB +B"
A!7ite! eritoniti! TB
H6 o!t tran!9&!i ,?, La6 1*12*1/ B ?. RB /? H6 ,?, HT /0?8 PLT /8. La6 2*11*201/ B ,?0 RB /?.4 HB ,? HT /0?, PLT 480 T*BT 8*2C/ PT*APTT 11?,*2,?5 r*r /*0?. @T*@PT 52*5 Na*+*3 1/5*4?2*10 2-11-1/ T !7an a6d a!7ite! eritoniti! ;oto tora ardio$e#a3y di3ata!i aorta E3eDa!i dia9ra#$a
RL Na3 A$$inoI& 111 28 t$ :P a36 /2 ta6 San$o3 1 #r*8'*iD LeDoIoa7in 1 #r*12 ' Ranitidine 1 a$*8' MetronidaJo3e 1 a$3*8'a$*iD
25 Bed 4 Ma'id Paa3ia 10*0*1,.2 RM .//0 MRS 24*10*201/ "i%on!&3 dari T! interna t#3 28*10*201/
"* PH 1. #a!tro!to$i 9eedin# e7 t& E!oa#&! 1*/ di!ta3
La6 /*12*1/ B 4?. RB /?2. HB 8?, HT 2.?8 PLT 1,, La6 (/0*11*1/ B .?2 RB /?0/ H6 8?/ HT 25?1 PLT 14/A36 2?4 La6 (21*11*201/) B 5?.? RB /?2.? HB ,?/ HT 2?/?
:;" RL a$inoI&id Na3 0?,< 111 2 t$ Metronida!o3e 0?5#r* Ranitidin a$*8'*iD e9triaone 1#r*12'*i "iet !&!& 100 77*2'
1/
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 "rdr6rai$ La6eda SB +B"
T&$or e!o9a9&! !&!e% $a3i#nan7y T o3e a6do$en tana %ontra! (25*10*201/ +e!an ene6a3an dindin# #a!ter !&!e% $a!!a eato$e#a3y ;oto tora PA (25*10*201/) +e!an 6ron7iti! non !e!i=%
e% 6 o!t tran!9&!i
LNTARA 2 "@EST:E +AMAR / (EML 0852,,,2,,1/) 2. Bed 1 Ro6in ood
5-10-1,,. .401,1 MRS /-12-201/ "r !a$&e3 SB +B"
"* Tra&$a t&$&3 a6do$en
La6 /-12-1/ @"S1/ r*r 22*0? @T*@PT 10*5 Na*+*3 1/1*4?2*101 T*BT C/0* /G PT*APTT 14?1* 2/? B 8?,. RB 4?84 HB 1/?8 HT /8?, PLT 422
:;" Na3 28 t$ e9triaone 1#r*12* Ranitidin 1 a$*8 ' Awa!i tanda a%&t a6do$en dan T:
2 Bed 2 di /1-12-1,54 ./425 MRS 2,-11- 201/ "rdr6rai$ L SB +B"
"* T& ae7&$
T !7an tora (25-11-1/) Meta!ta!i! t& %e ar& den#an 3y$adenoaty eri6ron7ia3 -%3a!i=%a!i +@B !&67arina T !7an a6do$en (20-10-1/) Ma!!a 7ae7&$ den#an tanda i3e&! o6!t ;oto tora%! 20-11-1/ Tanda $eta %e ar&
RL 20 t$ Ranitidin 50 $#*8'*i +etoro3a7 /0 $#*8 ' "iet 6e6a! T&n##& a!i3 S@ a dan ro 7o3on in 3oo
28 Bed 4 Pranoto /1*12*1,.5 ./.85. MRS 1/*11*201/ "r dr 6rai$ La6eda? SB- +B!e$en
"* PH 2 3aaroto$i e7 $e#ae!o9a#& !
La6 /0-11-1/ B 2.?0/ RB5 H6 11?8 HT/.?. PLT 4.0 E7o7ardio#ray - di!9&n#!i !i!to3i% L: 6ai%? E; .8< - di!9&n#!i dia!to3i% La6 12*11*201 B 12?, RB 4?48 HB ,?, HT /0?1 PLT 48 @"S 88 r 14 r 0?8 S@T 22 S@PT 12 Na 1/. + 4?4 3 104 T 8C00 BT /C00 APTT 2?.(22?2) PT 14?1(11?8) H6!A# non rea%ti9 e!oa#&! (/0-10-201/) Me#ae!o9a#&! den#an =33in# de9e7t
e9triaone 1 #r*12 -%etoro3a7 /0 $# * -PT /500 Ranitidine 50$#*8 ' Ren7ana o %a$i! 5*12*1/ +on!&3 erioerati9
14
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 ada !i!i %anan ( aa%a !&at& $a!!a ata& $a!!a den#an 6eJoar) Hernia!i #a!ter di!ertai tanda-tanda &3%&! #a!ter a%&t den#an !&! Ma!!a di daera 9&nd&! ;oto tora PA*AP (12*11*201/) !o9t ti!!&e $a!! den#an 6eJoar dida3a$nya (!&! Me#a e!oa#&!) MST :ete6ra Tora%a3 S3idin# ernia Me#ae!o9a#&!
2, Bed / Fo!e Mowend& 22-0,01,4 MRS 4*12*1/ RM .//2.2 "rdr Rona3d SB+B"
Pro %e$oterai !i%3&! 2
LNTARA 2 Beda "i#e!ti9 +AMAR 10 (i!wanto 085254/2525) /0 BE" 1 Ny Hadia
1*10*1,.0 K 5/ ta&n MRS 18-11- 201/ RM ./8001 FAM+ES"A
+i!ta Me!enteri&$
La6 2-11-201/ B 4?/ RB /?04 H@B ? HT 24?8 PLT 21. S@ A6d 2.-11-201/ Ma!!a $e!enteri&$ 6er!eta3 di!ertai a!7ite! o3e3it La6 2/-11-201/ B 4?,0 RB /?/5 H@B 8?. HT 2.?4 PLT /4, La6 21-11-201/ RB 2?2. H@B .?/ HT 20?4 PLT 2.8 B 5?0 La6 20-11-201/ RB 1?,. H@B 4?/ HT /4? PLT 2.0 B 4?/ La6 18-11-201/ B 4?/. RB 1?4. H@B 2?. HT 10?/ PLT 21/ T*BT 8C*/C PT*APTT 12?5*21?, @"S 120 r*r 18*0? @T*@PT 1*, Na*+*3 140*4?0*11/ PA /-10-201/ airan +i!ta Me!ote3 Pro3i9erati9 den#an inIa$a!i (airan Peritoni&$) +i!ta He$ora#i% (airan +i!ta)
Parade ren7ana oe e9triaone 1 #r*12'*i Ranitidin 50 $#* 8'a +etoro3a7 /0 $#*8 'a "iet 6e6a!
/1 Bed 2 H' Fia P*80 ta&n MRS /0-11-2-1/ RM ./,4,
PH draina!e T&$or adne%!a Mei# Sindro$
La6 t#3 2-12-201/ RB 4?,0 H@B 1/?5 HT 42?1 PLT 250 La6 /0-11-201/ S@PT 45 rotein tota3 5?/ a36&$in /?1 #3o6&3in 2?2 Na*+*3 1/.*4?0*112 T S7an t#3 2,-11-201/ Ma!!a %o$3e%! adne%!a E9&!i 3e&ra 6i3atera3 La6 tan##a3 28-11-201/ T 8?00 BT /?00 PT 12?, APTT 2 @"S 25 r 21 r 0?, S@T 1.8 rine R&tin 28-11-201/ arna +&nin# a#a% %er&? rotein /*Q/00 #3&%o!a 2*250 63ood
:;" RL " 5 < 11 1 t$ Ranitidine 1 a$*8'*ii +etoro3a7 / #*8'*iD e9triaone * 12'a$*i
15
/2 Bed / Na'e P*44ta&n*/-- 1,.,
2.-10-201/ RM ./4/./ F+" "r6rai$ La6eda?SB(+) B"
T&$or re7ti 1*/ di!ta3 t&$a$a (S) !&! Pi3oide!
La6 (2.*11*201/) B 1?18 RB/?., H@B 10?. HT 2,?, PLT 52. 6i3ir&6in tot 0?5 S@T 21 S@PT
La6 (2.*11*201/) A36 2?4 B 1?5 RB /?1. H@B 8?, HT 2?4 PLT 410
La6 (2/*11*201/) B 1.? RB 2?.1 H@B ?4 HT 22?1 PLT 280 @"S 128 &r*7r 1/*0?4 S@T*S@PT 1/*, rot tot /?4 A36 1?, Na*+*3 1/4*2?*108
La6 (21*11*201/) @"S 8 Prot tot /?8 A36 1?, B 1,?, RB /?/5 H@B ,?/ HT 2.? PLT 158
La6 18*11*201/ PT*APTT 11?*/0?, NR 1?00 Na*+*3 1/5*2?.5*10, @"S 11 &r*7r 10*0?4 A36&$in 1?, S@T*S@PT /4*15 Protein Tota3 /?1 @3o6&3in 1?2 La6 18*11*201/ B 2/?81 RB 2?/. H@B .?/ HT 18?. PLT /2. La6 1/*11*201/ ;e$itin ,5?41 PT*APTT 1/?5*/1?0 NR 1?12 Na*+*3 12,*4?5*101 A36&$in 2?5 %o3e!tero3 tota3 210 %o3e!tero3 H"L 20 %o3e!tero3 L"L 14/ tri#3e!erida 21, 7a3!i&$ ?/ $a#ne!i&$ 1?. ;e(6e!i) 2 TB 1/. @"S 85 &r*7r 11*/?, S@T*S@PT 1*8 Protein Tota3 8?1 La6 1/*11*201/ B 14?,5 RB /?1. H@B 8?/ HT 24?4 PLT /,, La6 /1*10*201/ Protein tota3 .?1 A36&$in 2?2 Na*+*3 1/.*/?5*10 La6 /1*10*201/ B ?5 RB 4?14 H@B 10?1 HT /1?0 PLT /,1 La6 2.*10*201/ B 1044? RB /0? H@B 8/? HT 20? PLT 4/2 S@ A6d 2.*10*201/ +e!an Ma!!a ron##a e3Di! !e!&ai &nt&% $a!!a re7to!i#$oid ;oto Tora 2.*10*201/ -S&! T& $eta!ta!i!%e ar& dd* ne&$onia &3$o detra -3e&ra rea7tion detra T !7an a6d 2*10*201/ -Ma!!a re7to!i#$oid yan# $en#in=3tra!i &ter&!
:;" a$inoI&id Na RL Pan A$in @ 11 iroIoa7in 200 $#*8'*iD Ranitidine a$*8'*iD 7airan Di A36&$in /2 diet 6e6a! $o6i3i!a!i a%ti9
1.
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 -nod&3 !o3iter ar& %anan !&! t&$or $eta!ta!i!
// Bed 4 Hadaria*P*2 tn*1--1,8. ./510/ MRS /1*10*201/
Fa$%e!$a!
T&$or a6do$en !&! Li$9o$a $a3i#na
La6 t#3 /*12*01/ Na 122 + 2?.? 3 ,?5 La6 t#3 /0*11*01/ RB 4?41 H@B 12?0 HT /.?1 PLT 4, M: 8/ MH 2?/ La6 2.-11-201/ @"S 52 r*r 40*0?2 @T*@PT 2*2 Na*+*3 12.*/?5*111 T*BT 8C00G*/C00G PT*APTT 14?,*21?8 B ?2 RB /?/8 H@B 8?. HT 2.?2 PLT /. La6 24-11-201/ B 1// RB /. H@B ,81 HT 2,, PLT 2 r*r 2,*08 @T*@PT /0*40 ProtTot 5, A36 24 Na*+*3 1/2*28*108 +o3 Tot 12, La6 18*11*1/ B 5?4 RB 5?02 H@B 1/?0 HT /?. PLT 2/. @"S ,4 r*r /*0? @T*@PT 22.*.8 Na*+*3 124*/?0*81 La6 15*11*1/ B 4?4 RB 4?4 H@B 11?, HT /4?0 PLT 420 @"S 0 r*r 25*0? S@T*S@PT 2,*1/ T*BT 8C*/C PT*APTT 1/?4*24?. NR 1?11 Na*+*3 11,*2?4*. La6 5*11*201/ Na*+*3 1/*2?5*8 La6 1*11*201/ @"S 1 re&$ 28 +reatinin0?4 Bi3ir&6in tota3 0?28 Protein tota3 4?/ A36&$in 2?4 @3o6&3in 1?, Na 1// + /?8 3 100 B 12?54 RB 2?88 H@B ?0 PLT 5.0 La6 /1*10*201/ B 8?8 RB 5?1. H@B 1/?4 HT /8?, PLT 4// @"S 8. R*R /0*0?, @T*@PT 50*20 NA*+*L 12.*2?/*1? T*BT 8C00G*/C00G PT*APTT 11?0*2.?,? Protein tota3 ?5 a36 4?2 S@ A6do$en /1*10*201/ Ma!!a araarrtae !&! Li$9o$a Hydrone9ro!i!detra T A6do$en ( /1*10*201/) %e!an $a!!a intraa6do$ina3 !&#e!ti9 3i$9o$a $a3i#na ydrone9ro!i! %anan a!7ite! ;oto Tora or dan &3$o nor$a3 Tida% ta$a% tanda-tanda $eta!ta!i! ada 9oto tora ini
n!tr&%!i o!t oera!i :;" RL Na3 0?, < 20 t$ e9triaone * 12'a$*i Ranitidine 1 a$*8'*ii +etoro3a7 / #*8'*iD Awa!i TT: e% 6io!y ato3o#i anato$i
/4 Bed 5 Ny Sitti M&rni 01*12*1,52
T&$or A6do$en
La6 t#3 28-11-201/ B 5?, R67 /?.1 H#6 ,? H7t 2,5
e% dara 3en#%a +on!&3 erioerati9
1
SABTU, 7 DESEMBER 2013 RM ./,/4 P3t /25
t*Bt 8C00*/C00 PT*APTT 11*21?. @"S 105 S@T*S@PT /1*18 Na*+*3 1/*4?.*102 r 42 r 1?4. a36&$in /?8 H6! A@ Non rea%ti9? EA 2?04
iroIoa7in 2500 A!a$ $e9ena$at / $# Ranitidin /1
/5 Bed . R&!ain A$ad 20-12-1,85 RM ./.,8, MRS 22-11- 201/
PH 1 e%!3ora!i B" e7 o3e3itia!i!
La6 t#3 2-12-201/ B ,?0. R67 4?81 H#6 1/?4 H7t /,. P3t //4 t*Bt 8C00*/C00 PT*APTT 1/.*2.?5 S@T*S@PT 120*1/5 Na*+*3 1/.*/4*104 r 15 r 0?., 2.-11-201/ Bat& di!ta3 B" di!ertai %o3e!tati% intra-e%!traeati% dan di!ten!i @B o3e3it 25-11-201/ a 1,-, 18?.1 T-S7an o3e A6do$en 12-11-201/ o3e!tati7 intra dan e%!tra eati7 !a$ai B" e7 6at& ada an#%a3 B" o3e3it S&! Mio$a teri
La6 12-11-201/ 67 / R67 /?,/ H#6 10?, H7t /11 P3t /2, t*Bt 8C00*/C00 PT*APTT 1/4*25 S@T*S@PT 181*/48 Na*+*3 140*/8*10. +o3 Tota3 2.4 H"L 45 L"L 1,.1 TB 11, A36&$in /8 Bi3 "ire% 5?2 a3%a3i 9o!9ata!e 50.
S@ A6do$en 12-11-201/ o3e!tati% e7 !&! 6at& B"
:;" RLNa3 0?, < 5< 111 28 t$ n' e9triaone 1*1 n' MetronidaJo3e #r*8'*iD n' Ranitidine 1 a$*8'*iD n'%etoro3a7 1 a$*8'*iD Bo3e $in&$ Ta%ar rod&%!i drai T t&6e*24 'a$ Ba3an7e 7airan
LNTARA 2 +AMAR 11 (Mo "i$a! !$ai3) /. Bed 1 Tn F&aren#
1**1,.1 .405// MRS 4*11*201/ F+M "ri6rai$ 3a6eda? SB +B"
PH . draina#e a67e!! !7rot&$
La6 4*12*201/ B 1?,1 RB 4?05 HB 11?2 PLT 4/, rottota3 4?1 A36 1?, @3o6&3in 1?, T*BT C/0*/C00 r*r 22*0?. @T*@PT 24*21 Na*+*3 1/1*/?.*10 @"S 110
:;" RL 28 t$ e9triaon 1 #r*12'a +etoro3a7 1 a$*8'a Ranitidine 1 a$*8'a MetronodaJo3e 0?5 #r*8'a$*iD +&3t&r &!
/ Bed 2 S&'iono* L*./ ta&n 01*0*1,50 (./1/2) MRS 0.*11*201/ Pena#ian
"* PH . 3aarato$i e%!3ora!i
2*12*201/ A36&$in/?4
2.*11*201/ B 10?2 ? H@B 11?4 ? PLT .1,? RB /?,2
20*11*201/
iroIoa7in 500 $# /1 Para7eta$o3 500 $# Ranitidin ta6 /1 "iet !&!&
18
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 "r dr Rona3d E L? SB-+B"
T 8? BT /? PT 1/?4? NR 1?11 APTT //?2 Na 1/0 + /?.? 3 10/ H6!A# non rea7tiDe Anti H: non rea7tiDe? @"S 80? r 2 r 0?,? @T 5.? @PT /2? A36&$in 2?5 La6 12*11*201/ B /? RB /?51 H@B 10?4 HT 2,?4 PLT /05 Na 1/4 + /?8 3 105 @"S 84 r*r 15*0?8 S@T*S@PT 20*5 Protein tota3 .?2 A36 2?, A!rat .?4 T 8C BT/C PT*APTT12?8*2.?4 La6 *10*201/ B 5?. RB /?,0 HB 10?, HT /2?. PLT /, T 8C00G BT /C00G PT 11?0 APTT 2?. EA 1?01 @"S ,0 &r 21 7r 0?, @T 21 @PT . Na*+*3 1/1*/?,*108 +o3ono!%oi 1*10*201/ Ma!!a t&$or etra3&$iner in=3trati9 ro%titi! dera'at !edan# Bio!i 21*10*201/ Eite3 den#an di!3a!ia rin#an dan radan# %roni% a%ti9 S@ A6do$en (0,*10*201/) +e!an $a!!a etra3&$iner den#an e$6e!aran +@B Di33i &!&! o3on n3oo (0,*10*201/) +e!an T&$or re7to!i#$oid den#an tanda-tanda o6!tr&%!i in=3trati9 T-S7an A6do$en (0,*10*201/) +e!an Ma!!a re7to!i#$oid yan# in=3tra!i %e 'arin#an di !e%itarnya ("+ES )
;oto Tora R P&3$o da3a$ 6ata! nor$a3 3d ;ra7t&re 1*/ $edia3 o! 73aDi7&3a detra
/8 Bed / M& Tair*L*/2 tn 1,*12*1,80 (.2214.) MRS1,*,*201/ Fa$%e!$a!
"PFP "rdr6rai$ La6eda?SB- +B"
"*PH 20 Laarato$i E3ora!i 3eo!to$i
;oto 3&$6o!a7ra3 2*11*201/ +e!an tida% ta$a% %e3ainan ada 9oto 3&$6o!a7ra3 ini n7identa3 =nd ta$a% di3ata!i 3oo- 3oo &!&! den#an #a$6aran earin# 6one La6 2*12*201/ B 4?,0 RB /?.4 #610? PLT 14 La6 2/*11*201/
r*7r /1*1?1? @T*@PT 44*45? A36 /?0 ? Na*+*3 140*/?8*10,? RB 4?22? HB 12?1? HT /.?,? PLT 401? B 5?
La6 1,*11*201/ Bi3 tota3 0?,4? Bi3 dire7% 0?2? @T 1/?
Mo6i3i!a!i d&d&% "iet 6e6a! T+TP e9adroi3 2500 $# LeDoIoa7in /500 A!a$ $e9ena$at / $# Ranitidine 2 150 $# :P A36&$in /2 ta6
1,
KORAN BEDAH DIGESTIF
A36&$in /?1? Na*+*3 1/2*/?.*101? HB!A# non rea7tiDe? anti H: (-)? B .? RB /?./? H6 10?.? H: 8,? PLT /1, rin R&tin 22*10*201/ arna %&nin#? H ?Prot(-)? #3&%o!a nor$a3? &ro6i3ino#en (-)? 63ood (-)? 3e&%o!it (-) La6 11*10*201/ 67 .?. RB /?,1 H6 11?. PLT /,, A36 /?4 La6 1*10*201/ @"S 124 R 11 r 0?. @T 1 @PT 1/ Prot tt3 .?1 a36 2?, T 8 BT / PT 1/?0 APTT 25?, Na 1/ + 4?4 3 108 B ?0 RB 2?/ HB ?1 PLT /15 La61,*,*201/ RB /?/4 B 14?. H#B 10?1 HT /0?/ PLT 2, @T*@PT /4*2 A362?1 Na*%*3 1/5*/?,*108 H6SA# (-) T*BT 8?00*/?00 PT*APTT 1/?4712?4*/1?5 7 24@"S ,/ r*r 10*0?8 La6 21*0,*201/ A36&$in 2?.0? ;oto tora%! (2.*,*1/) E9&!i 3e&ra %anan ;i!t&3o#ray (1*10*1/) ;i!te3 entero7&tane&! S@ a6do$en 2.*,*201/ E9&!i 3e&ra %anan
/, Bed 4 Ha!'&n La%i-3a%i RM .//8/. T#33air 1-.- 1,0 // tn MRS 2/*10*201/ FAM+ESMAS
"r dr 6rai$ La6eda? SB- +B"
PH . 3aarato$i e%!3ora!i $i3e!C ro7ed&re
La6 2*12*201/ @"S ,/ r*r 21*0? @T*@PT 18*12 Na*+*3 1/5*/?*10. HB!A# non rea7tiDe B .?1 RB4?2, HB 12?8 PLT 250 La6 18*11*201/ B 15?,1 RB 4?15 H@B 12?4 HT /4?5 PLT 4// La6 1.*11*201/ re&$ 1/ %reatinin 0?5 @T*@PT 1,*1 Prottota3 4?, A36&$in 2?, @3o6&3in 2?0 Na*+*3 1/2*/?*,8 T*BT 8G*2C/0G PT*APTT 10?,*2?0 @"S 11.
@anti o6at ora3 e9adroy3 500 $# 2 Ranitidin /1 A!a$ $e9ena$at 50 $# /1
20
KORAN BEDAH DIGESTIF
Adeno7ar7ino$a dieren!ia!i !edan# La6 2/*10*201/ B ?0/?RB>4?/5 HB12? HT /.?0 PLT>42/ T>C00 BT> 2C/0 PT>,? APTT2.?2 @"S,. R> 1 R> 0?5 Na> 1/, %> /?. 73>100 HB!A# non rea7tiDe? anti H: non rea7tiDe ;oto tora PA*AP 2/*10*201/ +P detra a%ti9 Tida% ta$a% tanda-tanda $eta!ta!i! ada 9oto tora ini
40 Bed 5 Tn M&a$ir 1*1*1,5, ./88, 22*11*201/ F+"
PH 18 3aarato$i e%!3ora!i e7 er9ora!i #a!ter
La6 24*11*201/ r*7r /,*0?8 ? B 1,?2 ? RB /?58? HB ,?2 ? PLT /5
;oto tora 24*11*201/ +e!an !&! E9&!i 3e&ra " "i3atation et e3on#ation aortae La6 2/*11*201/
HB 1/?00 ? M: , ? MH 25?1 ? MH /1?8 ? PLT /4? B 2.?? HB!A# non rea7tiDe ? @"S 1//? @T*@PT 1//*
:;" RL Na3 11 e9triaone 1#r*8'a PantoraJo3e 40 $#*24'a$*iD Mo6i3i!a!i 'a3an "iet 6&6&r 6ia!a T+T LeDoIoa7in 1 #r*12' MetronidaJo3e 500 $#*8'a$ +&3t&r anti6ioti%
41 BE" . M&!tari d# n#an%a Tt3 18*.*.. ./08.1 Mr! 2,*10*1/ F%$ "r dr 6rai$ La6eda?SB- +B"
PH 1 3aarato$i e%!3ora!i re!e%!i i3e&$ 3ea%a#e ana!to$o!i! i3e&$ ter$ina3 i3eo!to$i
2/*11*201/ B 1.?/ RB 4?2 H@B 11?5 HT /4?1 PLT .8 T*BT 8*2?/ PT*APTT 1?4*//?1 Na*+*3 1/*/?1*112 22*11*201/ @"S .4 &*7r 21*0?, @T*@PT 2.*5 Prot Tota3 /?, A36&$in 1?, Na*+*3 1//*/?1*110 H6!A# (T) Non rea%ti9Anti H: Non Rea%ti9
1*10*201/ (9oto o3o! A6do$en) Tida% ta$a% %e3ainan radio3o#i7 ada 9oto o3o! a6do$en ini
*10*201/(o3on-n3oo) Ma!!a 7o3on tran!Der!&$ !i!i %anan !&!e% $a3i#nan7y
LeDoIoa7in 500 $# Para7eta$o3 500 $#
21
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 1*10*201/ ;oto Tora PA or dan P&3$o nor$a3 Tida% ta$a% tanda-tanda $eta!ta!i! ada 9oto tora ini
2*10*201/ (T A6do$en Ata!*Bawa) Ma!!a $e!enteri&$ re#ion %anan a6do$en
1*10*201/ (S@ A6do$en) Ma!!a intra3&$inar re#ion 3&$6a3 %anan 3e&ra %anan
LNTARA 2 N+L@ (Mo "i$a! !$ai3*081/42//45.)
LNTARA 2 RL@ ( Mo "i$a! !$ai3*081/42//45.) 42 +a$ar
11 6ed 1
oana P*5-,-1,.1 (52tn) RM ./5,1 MRS 14*11*201/ F+M
o3e!i!to3it ia!i! HT @r
La6 .*11*201/ B ?2 RB 4?81 H@B 14?1 HT 42?. PLT 2,0 @"S 142 r*r /1*0?, @T*@PT /,*21 A!&rat .? TBT 8C00G*/C00G NR 1?02 Na 142 + /?, 3 110 H6!A# (-) Anti H: (-) S@ *11*201/ +e!an ne9ro3it (S)? 7o3e3it La6 2*12*1/ T*BT 8*/? PT*APTT 12?? 28?4 NR 1?0.? @"S ,,? r*r 22*1?04? S@T*S@PT 2/*2/? Na 14/? + /?,? 3 112? B 8?8.? RB 4?.0? H@B 1/?8? HT /,?/? PLT 285
era!i ari ini
Tn Sain 10*.*1,.1 RM ./4/0/
PH /4 3aarato$i e%!3ora!i 7o3edo'e'&n o!to$i #a!troyeyeno !to$i
;oto 3&$6o!a7ra3 AP 3atera3 4*12*201/ +e!an tanda-tanda $&!73e !a!$?!ondi3o!i! 3&$6a3i! rin#an?o!teooro!i! !eni3i! ;oto tora%! AP3atera3 4*12*1/ +e!an !ondi3o!i! tora%a3i!?o!teooro!i! !eni3i! La6 1,*11*201/ B 15?, RB /?42 H@B 10?1 HT 28?2 PLT 22/ r*r 14*0?5 @T*@PT 40*/0 TT PRT .?/ ALB 2? Na*+*3 1/,*2?4.?10/ @"S 120 La6 10*11*201/ B 15?/1 RB /?. H@B 10? HT 28?/ PLT 202 PT*APTT 10?8*/8 Na*+*3 1/.*2?4/*10/ @"S 12. BL TTAL 8?1/ BL "RE+ 5?,0 @T*@PT /2*55 ALB 2?4 La6 8*11*201/ B 1.?. RB /?18 H@B ,?5 HT 28?4 PLT 114 @"S ,1 r*r 10*0?5 BL TTAL 10?1 BL "RE+ ,?2 @T*@PT ,?2*.1
"iet 6e6a! T+TP :;" RL"5 28 t$ Ranitidine 1 a$*8'*i +etoro3a7 1 a$*8'*iD e9triaone 1 #r*12'*i :P A36&$in / 4 ta6 HP ro /1 +on!&3 orto? rawat !a$a
LNTARA 2 RTHPE" ( Mo "i$a! !$ai3*081/42//45.) LNTARA / MATA (Mo "i$a! !$ai3*081/42//45.nto 085254/2525)
44 +a$ar 2 6ed 2
A Ha!yi$ Se!!& 22-0.-1,4, RM ./,/.
PH . HL (S) ireoni6i3i!
;oto tora 0/*12*201/ ardio$e#a3i di!ertai di3atation et atero!73ero!i! aortae
:;" RL"511 28 t$ n'e%!i ranitidine 1
22
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 MRS 2,*11*201/ E7o7ardio#rai 28 -11-201/
"i!9&n#!i dia!to3i7 L: L:H E; 4 <? AR $oderate Ha!i3 La6 28-11-21/ B .?/ RB 4?2, H@B 1/?/ HT 41?2 PLT 22 T*BT 8C00G*/C00G @"S 1/1 r*r 4, * 1?2 @T*@PT 2*/5 PT*APTT 10?,*25?/ Na*+*3 1/,*4?4*10
a$*8'*iD n'e%!i 7e9triaone 1#r*12'*iD n'e%!i %etoro3a7 1 a$*8'a$*iD Bo3e $in&$ Bo3e $a%an 'i%a tida $&nta Ren7ana &3an# ari
45 +a$ar 1 6ed
2
Na$a Ro!$iati ae /2 Ta&n Medi! ./,2/8 MRS 4-12- 201/
7o3e3itia!i! La6 t#3 0/*12*1/ S@T 2/S@PT 44 #a$$a 1.. La6 t#3 28*11*1/ Bi3ir&6in tota3 1?1.? 6i3dire7t 0?4? a3% o!ata!e ,.?a36&$in 4?1? &r*7r 11*0?,?Na*+*3 1/*4?0*101 La6 tan##a3 2.*11*1/ B 5?4 RB 4?., H@B 14?1 HT 40?8 PLT /48 T*BT 8C00G*/C00G @T*@PT /.8*/22 S@ t#3 2.*11*1/ +o3e!tati% intra dan e%!tra eati% e7 6at& B" ?o3e3it T S7an t#3 28*11*1/ o3e!tati7 intra dan e%!traeati7 e7 6at& di!ta3 B" ne&$o6i3ia o3e3it den#an 7o3e7y!titi!
Pro oera!i ari ra6&
LNTARA / BE"AH THT ( Mo "i$a! !$ai3*081/42//45.)
LNTARA / SARA; ( Mo "i$a! !$ai3*081/42//45.) 4. L1 BB
%1 B/ Ada$ T'aar ! RM 444 582 /1-12-1,45 +on!&3 dr Sara9
-He$oroid intern #r : -He$oroid eterna -He$iare!e (") Tyi7a e7 HS
PT1/?2 APP20/ @"S,8 r2/ %r11 S@T 25 S@PT1/ +o3e!tero3 Tota3 12 H"L 4, L"L105 Tri#3i!erida0, 7%40 %-M610 Troonin T0?02 Na1/. %/?8 +3114
Ardi&$ 2-2-2 ti$a3i!a!i +
LNTARA / +L-+EL ( Mo "i$a! !$ai3*081/42//45.)
LNTARA 4 @NE+L@ (He3en 08525//24/04 dan ;ir$an 08525/.05408) 48 +a$ar 4
Bed 4 Po3iati P*01-02- 1,./(50 ta&n) RM ./2,1 MRS 0*11*201/ Fa$%e!$a!
Po!t o draina!e a!7ite!
+o3e3itia!i! +i!ta ear +i!ta Me!enteri&$ PH . draina#e a!ite!
02*12*201/ A36&$in 2?0 2,*11*201/ B ?2, RB /?. H@B ,?0 HT 28?. PLT /,2 24*11*201/ A36&$in ?0 B ?2, RB /?. H@B ,?0 HT 28?. PLT /,2 La6 15*11*201/ B 5?,2 RB /?24 H@B ? HT 24?1 PLT 41/ T*BT 8C00*/C00 r*r 22*0?, @T*@PT 2/*14 A36&$in 2?2 La6 2/*10*201/ A125 /581,, T A6do$en
@: er ari Sto in9&!e A n9&! e9adroi3 2500$# Ranitidine /1 A!a$ $e9ena$at / A %ateter
2/
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 Ma!!a oDari&$ %iri +i!ta Me!enteri&$ +i!ta ear o3e3it A!ite! E9&!i 3e&ra detra La6 1*10*201/ B 5?4 RB 4?. HB 10?, PLT 55 Na 141 + /?, 3 10, @"S 111 r 21 r 1?0 @T 1, @PT . A36 /?/ T 8 BT / PT 12?4 APTT // S@ A6do$en 18*10*201/ Ma!!a %o$3e%! oDari&$ %iri +i!ta ear o3e3it A!ite! dan e9&!i 3e&ra %anan
4, +a$ar . Bed 4
Sa3i$a /1*12*1,.4 RM ./5258 MRS 1*11*1/
N+ Ma3i#na E9&!i 3e&r 6i3atera3 A!7ite!
P draina!e a!7ite! H-20
La6 28*11*201/ A36&$in 2?2 La6 2.*11*201/ B 1/?5/ RB 4?1. H@B 11?5 HT /2? PLT 55 La6 11*11*201/ A36&$in 1,0 La6 5*11*201/ B 14 RB 4/4 H@B 125 HT /51 PLT 4.1 r*r 8/*1?5 @T*@PT 28*1 Na 1/. + 41 3 105 La6 1*11*201/ B 8?8 RB 4?.. H@B 1/?2 HT /?2 PLT 40, HB!A# non rea7tiDe A! &rat .?/ r*+r .0*1?/ S@T*S@PT /4*1/ A36 /?/
Terai !e!&ai TS BT+ Ta%ar rod&%!i 7airan*ari
50 +a$ar 5 6ed 2
;at$a Sin'ai 10*10*1,5/ MRS /0*11*201/ ./,8./
A!ite! T& Adne%!a
La6 05*12*201/ B 10?.. RB /?84 H@B 11 HT /2?8PLT /1. La6 01*12*1/ T*BT *2 PT 11?2*10?8 APTT /0?2*25 @"S 104 r*r 84*0?, @T*@PT 42*11 B 12?24 RB 2?8. PLT 4?/ H@B ? HT 2/? MST 2*11*201/ +e!an $a!a %o$3e%! adne%!a? a!ite!
(He3en 08525//24/04 dan ;ir$an 08525/.05408) 50 Lt 2
%a$ar 11 B1
Ny H' St Sya$!ia 5,,1,. *.*1,55 (58tn) AS+ES MRS 14*11*201/
T&$or re%ti 1*/ ro%!i$a3 ? !&! $a3i#nan7y
La6 25*11*201/ o3on in 3oo +e!an !&!e% t&$or re7to!i#$oid La6 18*11*201/ EA 1?/0 ALB 2?8 La6 14*11*201/ @T*@PT /2*1, ALB 2?8 Na*+*3 1/5*/?22*101 B .?. RB 4?22 HT /?/ PLT /,8 H@B 12?4 PT*APTT 12?.*22?, NR 1?0 @"S 21. r*r 1/*0?5 T*BT 8C00G*2C00G T S7an A6do$en (12*4*201/) +e!an tida% ta$a% $eta!ta!i! ada T !7an a6do$en ini
"iet T+TP Mo6i3i!a!i d&d&% Terai !e!&ai TS nter Bi3a nyeri +etoro3a7 $# *8'a$ *iD Ranitidin 50$#* 8'a$
24
KORAN BEDAH DIGESTIF
SABTU, 7 DESEMBER 2013 Endo!%oi (28*/*201/) +e!i$&3an e$orroid eterna? e$orroid interna #r ? T& Re7ti !&! Ma3i#na S@ (20*11*201/) +e!an T& $eta!ta!e ear? e9&!i 3e&ra 6i3atera3 (NA"A 0821,/,82200)
25
5/ Lt/ /14
Ny Marta Tt3 2.*5*1,45 R$ 5814/0 Mr! 1*12*201/ "i%on!&3t#3 4*12*201/
"r dr ar!in##i? SB-+B"
aLida Pro #a!tro!to$y 9eedin#
La6 5*12*201/ 67 /.8 r67 282 #6 8. 7t 25. 3t /4/ La6 2*12*201/ @d! 1, !#ot*!#t 25*10 Na*+*3 1/8*4*100 &r*7r 1*0/,
Per6ai%i + Terai3an'&t TS 6edaon%o3o#idanintern
54 Lt4 %40.
"r dr Rona3d E L&!i%ooy SB-+B"
HL (") Reoni6i3iti!
La6 /*12*201/ 67 , r67 440 #6 12. 7t /.8 3t 40 BT /00 T 00 PT 1// APTT 2/ #d! 11, &r*7r /.*102 a!&rat .5 #ot*#t 1,*18 ;oto tora a /*12*201/ nor$a3
D9d RL 28 t$ Sta6iine 1 #r*12' ;arnat 0?5 #r*8' ;arain a$*8'
RSU (ANA 081341804!)
55 RSH 408
N&raeni Mr! 2*12*201/ R$ 0155,8 Tt3 20**1,8
Po 1 e$oroide%t o$i
3a6 28*11*201/ w67 ,4/ r67 482 #6 128 3t 24 7t /81 #d! ,5 &r*7r 5*05 6t*7t /C*8C
D9dr3 24tt!*$nt e9triaone 1 #r*12*iD Ranitidine a$*8'*r +etoro3a7 a$*8'*r NoIa$i7yn!yr 21 Ardi&$ /1 Laadyn !yr 21 Min&$ 6e6a! Awa!i%&ttD
5. RSH 424
"e6ora Sa3indin# RM 01.0.4 2,*12*1,.4 (4, ta&n) MRS 20*11*201/ AS+ES
dr Main7ara? S B K +B"
Po / 3aaroto$y aende7to $y
;oto o3on in Loo t#3 28*11*201/ Tanda-tandaeradan#an aendi den#anro7to7o3iti! La6 20*11*201/ B 4?/2 RB /?.5 H@B ?/ HT 25?4 PLT /,, Na*+*3 141*/?.*105 T*BT */ PT*APTT 1.?5*/1?0 S@T*S@PT 14*5 @"S 11/ r*r 28*0?8 HB!A# ne#atiDe Anti-H: ne#atiDe S@ A6do$en 1,*11*201/ +e!an Aendi7iti!
raDit 21 Ranitidine 21 Oy#aDit 11 @Da#i*!ore Teraiinterna3an'&t
5 RSH 41. A
"arwi! Ma7$&d /1*12*1,58 RM 010/. MRS 12*11*201/ di%on!&3t#3 14*11*201/ AS+ES
"r dr ar!in##i? S B K +B"
A67e!! 3&$6a3detr a Po!t 3aaroto$y aende7to $y
La6 /0*11*201/ @d! 10, La6 2*11*201/ B5?42? RB /?5. H@B 10?. HT /1?. PLT 252 A36&$in /?/ @"P 10. Ha!i3%&3t&r &! 14*11*201/ LeDoIoa7ine !en!itiDe La6 12*11*201/ B .?4 RB /?24 H@B ,?8 HT 2,?/ PLT 24 S@T*S@PT 8*8 r*r /5*1?0 A36&$in /? La6 4*12*201/ @d! 1/.
raDit 21 Ranitidine 21 Oy#aDit 11 @D a#i*!ore "iet 6ia!a Mo6i3i!a!i 'a3an
2.
Be d4
Ny "a$ari! Pa!a A!%e! ./.,48 12*10*1,5/ Pere$&an MRS 2*11*1/
Po!t 3aaroto$y e%!3ora!i e7 er9ora!i %or&! #a!ter t& @a!ter 'e'&no!to$ y 9eedin# PH
Ana3i!a #a! dara 05*11*201/ PH // 2 .0?/ S2 80? 2 48?8 H/ /2?2 7t2 14?4 BE 5?/ A@" 04*12*201/ H ?50? S02 ,,?1? 2 4.?5? H/ 11,?.? H/ /.?. 7t02 1.?8? BE 2?. La6 04*12*201/ Na*+*3 14,*/14*1// T*BT 8C/0*/C00 PT*APTT1.?2*/2? NR 1?/4 @"S 158 S@T*S@PT 50*/. B .?4 RB 4?1, H@B 11?2 HT /4?2 PLT 10, %e!an a3%a3o!i! $eta6o3i7 ter%o$en!a!i !e$&rna ;oto tora 04*12*201/
- ETT den#an &!&! di!ta3 ada $ain 6ron7&! %anan
- ardio$e#a3y di!ertai ede$a &3$o
- or&! a3ine&$ (e3&r&) ada e$itora %anan
-
La6 1*12*201/ B ?4 RB 4?20 HB 11?2 HT /5?1 PLT 50 r*r 8,*1? @T*@PT 4*4/ Na*+*3 1/* /? *118 Ana3i!a #a! dara 1*12*201/ PH 2. 2 5? S2 ,08 2 .? H/ 2.?2 7t2 15?. BE -1?0 La6 /0*11*201/ B ,?24 RB 4?14 HB 11?. HT /4?4 PLT .4 T*BT 8C00*2C/0 PT 1.?5 7ontro3 12?5 NR 1?/ APTT 4/?4 7ontro3 24?5 @"S // r *r 8.*1? A36 2?/ Na 145 + 4?0, 3 11. ;oto tora AP 1*12*201/ Ede$a &3$o d#n e9&!i 3e&ra 6i3atera3 or&! a3ine&$ (e3&r&) !etin##i araDerte6ra : T
;oto tora AP 28*11*201/ +P d&33e 3a$a a%ti9 or&! a3ine&$ (e3&r&) !etin##i araDerte6ra : T
;oto o3o! AB" / o!i!i 28*11*201/ Tanda Ktanda o6!tr&%!i &!&! a3&! dan er3en#%etan "i!tended #a!ter
Ana3i!a #a! dara 2,*11*201/ PH 25 P7o2 /8. S2 5,?, P2 /84? H/ 14 7t2 1., 7t2 18/ BE -85
"rdrRona3d L&!i%ooy?SB -+B"
He$orroid int #rade :
La6 2,*11*201/ 67 8?, r67 4?/0 6 12?4 7t /?8 3t /.0 $a3aria $i%ro!iti% (-) La6 /*12*201/ Sedi$en &rine eritro!it 0-1 Le&%o!it 0-/ Eite3 2-/
Terai3an'&tdrinterna "iet 3&na% ardi&$ /1
5, /15 A#&n# M&a$$ad Mr! 28*11*201/ 10*11*1,, R$ 01/82,
"rdrRona3d L&!i%ooy?SB -+B"
Po . aende7to $y
La6 28*11*201/ Pt 1,?8 att //?5 w67 15?2/ r67 5?50 6 15?/ 7t 44?2 3t /25
A in9&! Mo6i3i!a!i 'a3an @D !e6e3&$ &3an# e9adroy3 2500 A! Me9ena$at /500$ "iet 3&na% Bo3e &3an#
.0 RSH 424
Debora Salinding RM 01.0.4 2,*12*1,.4 (4, ta&n) MRS 20*11*201/ AS+ES
dr Main7ara? S B K +B"
Po 2 3aaroto$y aende7to $y
;oto o3on in Loo t#3 28*11*201/ Tanda-tandaeradan#an aendi den#anro7to7o3iti! La6 20*11*201/ B 4?/2 RB /?.5 H@B ?/ HT 25?4 PLT /,, Na*+*3 141*/?.*105 T*BT */ PT*APTT 1.?5*/1?0 S@T*S@PT 14*5 @"S 11/ r*r 28*0?8 HB!A# ne#atiDe Anti-H: ne#atiDe S@ A6do$en 1,*11*201/ +e!an Aendi7iti!
Terai 3an'&t A %ateter Mo6i3i!a!i d&d&% "iet 6&6&r !arin#
.1 RSH 42.
Dr! dr! Ronald E! "# S$!%&K%D
HL (") re%&ren!
lab 5/12/201 w67 .,1 r67 5.4 #6 12 7t 502 3t /0, Na*+*3 140*/,*101 S@T*S@PT /.*54 a36&$in 4. @"S 181 &r*7r 25*1/ 'o(o ()ora* $a 5/12/201 Tida%ta$a%%e3ainan radio3o#i7 E+)o 6/12/1 "i!9&n#!i dia!to3i7 L:? L:H? E; .5<
Ren7anaoera!iari!a6t *12*201/ 000 P&a!a 8 'a$ !63$oera! Pi%&3 5 a#i$a!&%%and&37o3a o!taria 1
.2 /0. tn A$ad $r! 22*11*201/ di%on!&3t#3 /0*11*201/ 1*12*1,5, R$ 01.14/
"rdrRona3d L&!i%ooy?SB -+B"
He$orroid int #rade :
"ab 29/11/201 67 8?, r67 4?/0 6 12?4 7t /?8 3t /.0 $a3aria $i%ro!iti% (-) "ab /12/201 Sedi$en &rine eritro!it 0-1 Le&%o!it 0-/ Eite3 2-/
Terai3an'&tdrinterna "iet 3&na% ardi&$ /1
R"
2