Post on 01-Mar-2018
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 1/28
AZIZAH RIDWAN
110.2009.050
PRESENTASI KASUS
Hepatocellular Carc!o"a e.c
Hepatt# $ Kro!%
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 2/28
IDENTITAS PASIEN
Na"a & T!. ' (e!# Kela"! & )a%*la%
U"ur & +, ta-u! Ala"at& Sura!e!ala Su%u & (a/a Pe%eraa! & Pe!#u!
Aa"a & I#la" Statu# Per%a/!a! & 'e!%a- Tl. 'a#u% & 1+*0+*1
Tl. Keluar & 19*0+*15
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 3/28
ANAMNESIS
Keluhan Utama:
Ner perut %a!a! ata#
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 4/28
Riwayat Penyakit Sekarang:
Pa#e! 4ata! 4e!a! %elu-a! !er perut%a!a! ata# #ea% 1 "!u #eelu" "a#u% RS.Ner 4ra#a%a! teru# "e!eru# 4a! #e"a%!la"a %elu-a! !er a! 4ra#a #e"a%!erta"a- a-%a! o# ter%a4a! t4a% 4apat
"e!a-a! #a%t ter#eut. Pa#e! ua "e!elu-perut!a "a%! "e"e#ar. Pa#e! "e!elu-cepat %e!a! %a "a%a!. Na6#u "a%a!er%ura! 4a! erat a4a! a! "ula turu!
#ea% eerapa ta-u! ela%a!a! 4ar 5, % 78, %. Kelu-a! ua 4#erta "ual ta!pa"u!ta-. Kelu-a! ua 4#erta "e!cret ta!pa4#erta 4ara- er/ar!a %u!! 4e!a!
6re%ue!# : 8; #e-ar. $ua! ar %ecl er/ar!a#epert te-.
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 5/28
Pa#e! ua "e"l% %ea#aa!"e!%o!#u"# %aca!*%aca!a! atu%aca! ta!a- #ea% 15 ta-u! ela%a!a!.Pa#e! "e!a%u per!a- 4ra/at#eelu"!a %are!a pe!a%t #erupa %et%aeru"ur 20 ta-u! tetap pe!oata!!a
t4a% #ele#a. R/aat pe!u!a !ar%oa aru" #u!t% <*= r/aat tra!#6u# 4ara- <*=r/aat per!a- "e!u!a%a! tatto <*=r/aat "!u" al%o-ol <*=.
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 6/28
Riwayat Penyakit Dahulu
Pa#e! per!a- 4ra/at 4e!a! pe!a%t#erupa %et%a eru"ur 20 ta-u! 4e!a!eala a! #a"a tetap pe!oata!!at4a% #ele#a %are!a %eterata#a! aa
#e-!a pa#e! "e"!ta pula! pa%#a.Pa#e! ua t4a% "e!eta-u apa e!# 4a!#ea pe!a%t %u!! a! 44erta!a.
R/aat pe!a%t !al <*=
R/aat pe!a%t a!tu! <*=
R/aat pe!a%t T$ paru <*=
R/aat pe!a%t -perte!# <*=
R/aat pe!a%t D' <*=
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 7/28
Riwayat Penyakit Keluarga
R/aat pe!a%t %u!! <*=R/aat pe!a%t !al <*=
R/aat pe!a%t a!tu! <*=
R/aat pe!a%t T$ paru <*=R/aat pe!a%t -perte!# <*=
R/aat pe!a%t D' <*=
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 8/28
PEMERIKSAAN FISIK
Ke#a4ara! & Co"po# "e!t#
Te%a!a! 4ara- & 180>90 ""H
Na4 & ,8; > "e!t reuler
Per!apa#a! & 22 ; >"e!t
Su-u & ?10 C
T! $a4a! & 1+5 c"
$erat a4a! & 8, K
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 9/28
KEPALA
$e!tu% & Nor"al #"etr#Ra"ut & Hta" t4a% "u4a- ro!to%
'ata & Ko!u!t@a t4a% a!e"#
sklera ikterik
e4e"a palpera <*=
pupl #o%or %a!a! %r
ReBe%# ca-aa >
Tel!a & $e!tu% !or"al #"etr#H4u! & $e!tu% !or"al #eptu" 4 te!a-
t4a% 4e@a#
'ulut & $r t4a% #a!o## l4a- t4a% %otor
t4a% -pere"#.
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 10/28
LEER
$e!tu% !or"al 4e@a# tra%-ea <*= T4a% a4a pe"e#ara! %ele!ar tro44a! K$ (P t4a% "e!!%at <52=c"
H2F
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 11/28
T!RAKS
I!#pe%# & $e!tu% 4a4a %a!a! %r#"etr#
Perera%a! !apa# %a!a! %r.
Sp4er !ae@ <*=
Palpa# & Gre"tu# ta%tl %a!a! %r
Per%u# & So!or pa4a %e4ua lapa!paru
$ata# paru -at & I"S I# linea mi$%la&i%ula$e'tra
Pera!a%a! -at& negati(
Au#%ulta# & $S %a% r- *>* /- *>*
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 12/28
"!R
I!#pe%# & ctu# cor4# t4a% ta"pa%Palpa# & ctu# cor4# ICS )'CS
Per%u# & ata# a!tu! %a!a! ICS l!ea #ter!al# 4e;tra
ata# a!tu! %r ICS l!ea"4cla@cula #!#tra
ata# ata# a!tu! ICS III l!ea
para#ter!al# #!#traAu#%ulta# & $( I>II "ur! reuler u!
ta"a-a! & #! <*=
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 13/28
A)D!MEN
I!#pe%# & Ce"u! a#"etr#
@e!a %olateral <*= caput 'e4u##ae *+,
Palpa# & Nyeri tekan *-,
he.ar tera/a 0 1ari $i )A" 2 3 1ari $i)P42 .ermukaan /er/en15l2k5nsistensi keras2 te.i tum.ul6
)e! t4a% teraa
Per%u# & S-6t! 4ull!e# *+,
re$u. .$ kua$ran hi.5k5n$rium $e'tra
Au#%ulta# & $#! u#u# <= !or"al 12;>"e!t
<N ,*5;>"e!t=
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 14/28
8ENITALIA
T.A.K
EKSTREMITAS
Superor & Ha!at Erte"a pal"ar# <*>*=
Sa!o## <*>*=
Clu! !er <*>*=
e4e"a <*>*=
I!6eror & Ha!at
e4e"a <*>*=
Sa!o## <*>*=
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 15/28
PE'ERIKSAAN PENUN(AN
DARAH RUTIN
He"olo! & 1, >4l 110 7 1?0
)eu%o#t & 5+H 10>Jl 80 7 100
)"6o#t & 210>Jl 10 7 50
'o!o#t & 320 10>Jl 01 7 10
ra!ulo#t & 023 H 10>Jl 20 7 ,0
He"ato%rt & 81 50 7 550
'C & 9? J" ,00 7 1000
'CH & 09 p 2+0 7 80'CHC & 0 >4l 10 7 55
Tro"o#t & 1+0 10>Jl 150 * 800
KDS & ,2 ">4l
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 16/28
Gu!# !al
Ureu" & 29 ">4l 10 *50Kreat!! & 0,, ">4l 0+ 7 1,
Urc Ac4 & 80 ">4l 8 7 ?0
Gu!# Hat
* Prote! total & ?2 >4l ?0 7 90
* Alu"! & 9 >4l 5 7 50
* loul! & 92; >4l 15 7 0
* $lru! total & <20< ">4l 01 7 12
* $lru! 4re%& =2>= ">4l 00 7 025
+ $lru! !4re% & 02>; ">4l + 0?5
* SFT & 09 U>l 0 * ,
* SPT & 390 U>l 0 * 81
* Alkali .h5s.atase: 9?> U>l 0 7 25,
Ele%trolt
Natru" & 19""ol>) 1+ 7 185
Kalium : 920 ""ol>) 5 7 51
Clor4a & 105 ""ol>) 9? 7 111
Kal#u" & 11, ""ol>) 115 7 129
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 17/28
Urine rutin
War!a & %u!!
pH & +.0
$erat e!# & 1025Ntrt & <= po#t6
Prote! & !eat6
lu%o#a & !eat6
Keto! & !eat6
)iliru/in : *-, 3
Urol!oe! & 1
Se$imen
)eu%o#t & *8>)P$
Ertro#t & !eat@e
Eptel & 1*>)P$Kr#tal & !eat6
$a%ter & !eat6
Sl!4er & !eat6
Pemeriksaan Ser5l5gi
/sAg : =9?= N@ rea%
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 18/28
US8 A/$5men
e.ar
'e"e#ar teruta"a lou# %rtep tu"pul per"u%aa! aa% reuler te%#turpare!%" "ula -eteroe! %ap#ul t4a% "e!eal ta"pa% aa!a! "a##a-pere%-o% eru%ura! ?05 ; 1108 ; ?95 "" pa4a lou# %r -epar.
Ta"pa% tu"or tro"u# pa4a @e!a porta eru%ura! 228 "". e!a porta t4a%"elear 4a! @e!a -epat%a t4a% "elear
Kan$ung em.e$u
$e#ar !or"al 4!4! "e!eal t4a% ta"pa% atu > #lu4e.
Du%tu# ler !tra > e%#tra-epatal & t4a% "elear t4a% ta"pa% aa!a!-pere%-o% 4e!a! acoustic shaddow.
Lien
'e"e#ar te%#tur pare!%" -o"oe! -alu# t4a% ta"pa% "a##a. e!a le!al#
t4a% "elear.
Kesan:
Tu"or -at pr"er <hepatocellular carcinoma= 4 lou# %r 4e!a! a/al perlua#a!%e lou# %a!a! 4#erta pe"e!tu%a! tu"or tro"u# 4a! #plee!o"eal.
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 20/28
RESU'E
Pra eru#a 0 ta-u! 4e!a! !er perut %ua4ra!-po%o!4ru" 4e;tra 4#erta 4e!a! perut a!"e"e#ar a!ore%#a "ual pe!uru!a! erat a4a!.R/aat "a%a! %aca!*%aca!a! <= 4a! r/aat pe!a%t-epatt# a! t4a% #ele#a pe!oata!!a.
S%lera %ter% !er te%a! pa4a perut %a!a! ata# 4a!-epato"eal "e"e#ar 1 ar $AC 4a! 2 ar 4 $PL4e!a! per"u%aa! t4a% rata %o!##te!# %era# 4a! teptu"pul.
loul! M $lru! M SFT SPT M H#A Al%alp-o#pata#e M. US a4o"e!& hepatocellular carcinoma 4lou# %r 4e!a! a/al perlua#a! %e lou# %a!a! 4#ertape"e!tu%a! tu"or tro"u# 4a! #plee!o"eal.
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 21/28
DIA8N!SIS KERA
Hepatocellular Carcinoma e.c Hepatt# $ Kro!%
DIA8N!SIS )ANDIN8
Hepatocellular Carcinoma e.c Hepatt# C Kro!%
Sro## -epat#
Gatt l@er e.c !o!*al%o-ol%
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 22/28
PENATA)AKSANAAN
No! Gar"a%olo# & $e4re#t Det 2800%%al>-ar Terap Palat6
Gar"a%olo# & D5 20 tete#> "e!t
Ce6ota;" ; 1 ra" I U!tu% a!t!er & Ketorolac ; 1 a"p I
U!tu% "e!ata# pe!!%ata! a#a"la"u! & A!ta#4a ; CI Ra!t4! ; 1 a"p
F!4a!#e!tro! ; 1 a"p Hepatoprote%tor & Curcu"a ; 1 talet
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 24/28
GF))FW UPTanggal 12-05-13 13-05-13 14-05-13
Kelu-a! − Ner perut %a!a!ata#
− A!ore%#a
− Ner perut %a!a!ata#
− A!ore%#a
− Ner perut %a!a!ata# er%ura!
− A!ore%#a <*=Pe"er%#aa! #%
−Ke#a4ara!
− TD− Na4− Per!apa#a!− Su-u− $erat a4a!
C'10>90""H
,0;>"!t22;>"!t+0 C8, %
C'120>,0""H
,0;>"!t22;>"!t?0 C8, %
C'100>,0""H
,2;>"!t1,;>"!t+80 C8, %
'ata− S%lera %ter%
T-ora% Cor pul"o
A4o"e!− Ner te%a!− Pe"e#ara! -epar$A$$AK
< =Dl" ata# !or"al
< =
1 ar $AC 2 ar $PL'e!cret<=War!a te-
< =Dala" ata# !or"al
< =
1 ar $AC 2 ar $PL'e!cret <*=War!a te-
< =Dala" ata# !or"al
< =
1 ar $AC 2 ar $PL'e!cret<*=War!a te-
Da!o#a HCC e.c Hep $ %ro!% HCC e.c Hep $ %ro!% HCC e.c Hep $ %ro!%
Pe!atala%#a!aa!$e4 re#t
D5 20 tete#> "e!tCe6ota;" ; 1 ra" IKetorolac ; 1 a"p IA!ta#4a ; CIRa!t4! ; 1 a"pCurcu"a ; 1 talet
<=
<=<=<=<=<=<=<=
<=
<=<=<=<=<=<=<=
<=
<=<=<=<=<=<=<=
Pe"er%#aa! a!ura!ta"a-a!
Gu!# -at 6u!#!al Ur! le!%ap
H#A
US a4o"e!
7/25/2019 Presus 1 HCC
http://slidepdf.com/reader/full/presus-1-hcc 28/28
DAGTAR PUSTAKA
1. A!o!". )@er Ca!cer. OF!l!e. OCte4 o! 2011. A@alale 6ro" & UR) &-ttp&>>///."e4c!e!et.co">l@erQca!cer>pae10.-t"
2. $u4-u#o4o U!ul. Kar#!o"a Hat. Dala" & $u%u Aar Il"u Pe!a%tDala". (l4 I. E4# I. GKUI. (a%arta. 200?. Hal& 855*,.
. Du4ale D. C. Hepatocellular Carc!o"a. OF!l!e. OCte4 o! 2009.A@alale 6ro" & UR) &-ttp&>>///.!l".!-.o@>"e4l!eplu#>e!c>artcle>0002,0.-t"
8. (ulu#. ABato%#!. Dala"& a#troe!tero-epatolo. Sau! Seto. (a%arta.199?. Hal& ,+*,
5. S!- $. E.A. Datau. Hepato"a 4a! S!4ro" Hepatore!al. OF!l!e.OCte4 o! 200+. A@alale 6ro" & UR) &-ttp&>>///.%ale.co.4>le#>c4%>le#>0,Q150QHepato"aHepatore!al.p46 >0,Q150QHepato"aHepatore!al.-t"l
+. Stuart K.E. Hepatc Carc!o"a Pr"ar. OF!l!e. OCte4 o! 2010.A@alale 6ro" & UR) &-ttp&>>e"e4c!e."e4#cape.co">artcle>2,2,18*o@er@e/
?. Sula"a! Al. Tu"or Hat. Dala"& a#troe!tero-epatolo. Sau! Seto.
(a%arta. 199?. Hal& ?*8