DC Tn Salim

7/24/2019 DC Tn Salim

1/22

LAPORAN KASUS KEMATIAN

Nama : Tn.S RS : RSUH

Umur : 50 tahun Ruangan : ICU

Alamat : Buton No.Register : 0381!

"e#er$aan : "ega%ai &antor Tgl.'RS : 10 A(ril 015

Agama : Islam Tgl meninggal : 13 A(ril 015

Su#u : Bugis )o#ter Ruangan : *r. No+erio Taru#allo

Status (er#a%inan : su*ah meni#ah Chie, Ruangan : *r. Al*ian )ahlan

Anamnesis (Autoanamnesis)

Ri%a-at "en-a#it Se#arang

Keluhan Utama : lemas badan

"asien *i#onsul #e agian /n*o#rin metaoli# *ari agian e*ah *igesti, *engan #eluhan

lemas a*an -ang ti*a# *isertai #eringat *ingin -ang *ialami hari tera#hir *engan )S:2 mg4*l

*an )":18 mg4*l *ari anamnesis leih lan$ut *i#etahui ah%a (asien memili#i ri%a-at )' -ang

su*ah *i*erita (asien se$a# tahun 003 meng#onsumsi glien#lami* namun *i#onsumsi se6ara ti*a#teratur oleh (asien. "asien ti*a# memili#i ri%a-at mengguna#an insulin. Seelum (asien mengetahui

ah%a (asien men*erita )' (asien sering an-a# ma#an *an an-a# minum namun ti*a# *isertai

(ening#atan erat a*an -ang sesuai.(asien $uga sering BA& terutama malam hari 57 4hari

"asien masu# rumah sa#it (a*a tanggal 8727015 *engan ru$u#an *ari RSU) Bau7Bau

*engan #eluhan sulit BAB *an (erut *irasa#an tam(a# memesar se$a# minggu seelum masu#

rumah sa#it mual *an muntah a*a. )ari hasil (emeri#saan Ra*iologi *i RSU) Bau7Bau *i#ata#an

(asien men*erita #an#er usus lalu (asien *iru$u# #e ma#assar *an #emu*ian men$alani o(erasi *i

RSUH (a*a tanggal 9727015.

"asien $uga mengeluh atu# -ang ersi,at hilang timul *isertai *aha# -ang er%arna $ernih*an #ental -ang su*ah erlangsung se$a# tahun tera#hir. "enurunan erat a*an 8 #g *alam

ulan tera#hir #eringat malam ti*a# a*a ri%a-at eroat AT ti*a# a*a n-eri *a*a *irasa#an (asien

$i#a (asien atu# ri%a-at atu# *engan *aha# er6am(ur *arah ti*a# a*a sesa# na,as ti*a# a*a

Riwaat Pena!it Te"dahulu:

Ri%a-at (ernah mengalami lu#a (a*a tung#ai seelah #anan -ang ti*a# #un$ung semuh (a*a

tahun 005 *an harus #ontrol se6ara teratur *i (oli e*ah RSU) Bau7Bau untu# men$alani

(era%atan lu#a selama setahun

Ri%a-at (en-a#it $antung *isang#al

Ri%a-at n-eri *a*a seelumn-a ti*a# a*a Ri%a-at eroat AT *isang#al


2/22

Ri%a-at (ernah ter#ena in,e#si (aru *isang#al

Ri%a-at hi(ertensi *isang#al

Ri%a-at gangguan gin$al *isang#al

Ri%a-at men$alani #emotera(i *isang#al

Riwaat Kelua"#a:

A-ah :su*ah meninggal (a*a umur 0 tahun (en-ea ti*a# *i#etahui

Iu :su*ah meninggal (a*a umur !5 tahun (en-ea ti*a# *i#etahui

Sau*ara:(asien ana# #e73 *ari 5 ersau*ara 1 sau*ara su*ah meninggal (en-ea ti*a#

*i#etahui (asien memili#i sau*ara (erem(uan -ang $uga men*erita )'*an se#arang rutin

eroat

Ana# :(asien memili#i 3 orang ana# -ang masih hi*u( *an sehat

Ri%a-at #an#er *alam #eluarga ti*a# a*a

Riwaat P"ibadi:

"asien memili#i ri%a-at #eiasaan mero#o# se$a# usia mu*a *an rata7rata meng#onsumsi 17

ung#us4hari

Ri%a-at gemar meng#onsumsi *aging ti*a# a*a

PEMERIKSAAN $ISIK

&esan sa#it :sa#it se*ang

i;i :6u#u(

Tinggi a*an :153 6m

Berat a*an :28 &g I'T :19 #g4m

&esa*aran :Com(os mentis


3/22

Thora#s

"aru:

I :(ergera#an rongga thora#s asimetri#s (ergera#an (aru #iri tertinggal ti*a# tam(a#

barrel chest

" :ta#til ,remitus (aru #iri menurun setinggi ICS = (aru #anan menurun setinggi ICS=I

" :(er#usi re*u( setinggi ICS = (a*a hemithora#s sinistra *an setinggi ICS =I (a*a

hemithora#s *etra

A :Bun-i (erna(asan ron#ho+esi#uler %hee;ing ti*a# a*a +o#al ,remitus (aru #iri

menurun setinggi ICS = *an (aru #anan menurun setinggi ICS =I

antung:

I :i6tus 6or*is ti*a# terlihat

" :i6tus 6or*is teraa (a*a linea mi*6la+i6ularis ICS = #iri

" :(e#a# atas $antung #esan normalA :un-i $antung I *an II murni reguler un-i tamahan ti*a# a*a

A*omen:

I :*atari#ut gera# na,as tam(a# lu#a o(erasi tam(a# ter(asang *rain #e 6olostom- ag

A :"eristalti# #esan menurun

" :tim(ani n-eri #eto# ti*a# a*a

" :tim(ani n-eri te#an (a*a regio inguinal *e#stra *an sinistra he(ar *an lien ti*a#

teraa memesar n-eri te#an ti*a# ti*a# a*a

/#stremitas :oe*em (retiial ?4? a#ral hangat (ulsasi arteri *orsali (e*is *e#stra *an sinistra ?4?

tam(a# e#as lu#a (a*a *aerah (e*is *e#stra

&ulit :sa%o matang turgor normal i#teri# ti*a# a*a

Peme"i!saan Penun%an#:

Peme"i!saan &olon in Loo' (*+,-):

&esan:Tumor Colon trans+ersum (roimal

.a"ah "utin (/*+,-):

BC :8904u@RBC :28010!4u@

H :11g4*l

Ht :3!1

'C= :5 ,l

'CH :5 (g

T6 :!80004u@

Neutro,il :89

ANC :!2!9

EK0 (/*+,-):

Irama sinus


4/22

Reguler

HR:8 4menit

Normoais *e+iation

$oto tho"a1 (2*+,-):

/,usi (leura ilateral

Peme"i!saan hemostasis (2*+,-)

BT :3

CT :8

"T :133

A"TT :1

INR :10

Peme"i!saan !imia da"ah (2*+,-):

)S :2 mg4*lST :3 u4@

S"T :38 u4@

Alumin : gr4*l

Ureum :3 mg4*l

&reatinin :1 mg4*l

.a3ta" masalah:

,4.M ti'e * non obese

*4Tumo" &olon 'ost o' 5emi6ole6tom de1t"a7Illeostom

84E3usi 'leu"a bilate"al

45i'oalbuminemia

Pen#!a%ian:

1.)i(i#ir#an )' ti(e #arena *ari anamnesis *i#etahui (asien telah men*erita )' se$a# tahun 003

*engan ri%a-at meng#onsumsi glien6lami*e *engan )S 2 mg4*l *imana seelum (asien

ter*iagnosis men*erita )' ter*a(at a*an-a ge$ala trias )' (a*a (asien -aitu (ol-uria (ol-*i(si

(ol-,agi *isertai )S D 00 mg4*l. )imana *iagnosis )' *a(at *itega##an a(aila a*a ge$ala 3" *an

)SD00 mg4*l

Ren6ana dia#nosti!: 'onitoring )S (remeal (sm

"eri#sa )""

)"

"ro,il li(i*

Urinalisis rutin

HA16

Ren6anan te"a'i:

7Beri#an insulin *ri( sesuai (roto#ol

"eri#sa )S4$am

)S D 300 eri#an ! U4$am )S 007300 eri#an 3 U4$am


5/22

)S 100700 eri#an 15 U4$am

)S E !0 sto( *ri( insulin

Target )S 1207180 mg4*l

7)iet )' 100 ##al4hari

.)i(i#ir#an tumor 6olon #arena *ari anamnesis *i*a(at#an #eluhan sulit BAB *engan (erut -ang

tam(a# memesar se$a# minggu tera#hir *engan hasil (emeri#saan 6olon in @oo( *i*a(at#an

#esan:tumor 6olon trans+ersum (ro#simal

Ren6ana te"a'i:

Sesuai tera(i Teman se$a%at agian e*ah *igesti,

3.)i(i#ir#an e,usi (leura ilateral #arena (asien (a*a (emeri#san ,isi# *i*a(at#an (er#usi re*u( (aru

#iri setinggi ICS = *an (aru #anan setinggi ICS =I *an (a*a ,oto thora *i*a(at#an e,usi (leura

ilateral

Ren6ana dia#nosti!:

"emeri#saan s(utum BTA 3 gram $amur "ungsi 6airan (leura

"emeri#saan @)H serum *an (rotein total

Analisa *an sitologi 6airan (leura

@/)

Ren6ana te"a'i:

"un#si 6airan (leura

Usul #onsul agian (ulmonologi

2.Hi(oaluminemia *i(i#ir#an #arena *ari hasil la *i*a(at#an #a*ar alumin

Ren6ana dia#nosti!: ST

S"T

Ur

Cr

"rotein total

Ren6ana te"a'i:

"emerian alumin 0 1 otol42 $am

$ollow u'

10727015

0!.30

Interna

TT=:

T):1384! mmHg

N:84menit

R:194menit

S:3!!0C

Sa:9

Pe"awatan I&U ha"i I

1.)iaetes 'ellitus ti(e non

oese

S:

"asien mengeluh lemas mual

muntah

:

)S:305 mg4*l

Tera(i:

7Beri#an insulin *ri( sesuai

(roto#ol

)S D 300 eri#an ! U4$am

)S 007300 eri#an 3 U4$am

)S 100700 eri#an 15

U4$am

7Bila )S E!0 sto( *ri( insulin

*an (eri#sa )S (er $am


6/22

./,usi "leura ilateral

S:

Batu# sesa#

:

"aru:(er#usi re*u( (a*a #e*ua

(aru setinggi ICS =I (aru

#anan *an setinggi ICS = (aru

#iri

Foto thora:


3.Tumor Colon Trans+ersum

(ost o( hemi6ole6tom- *etra

S:

N-eri (a*a *aerah lu#a o(erasi

:

=AS s6ore:5410

Ter(asang stoma

"eristalti# usus

@a:

BC:9290 890

Neutro,il:3 89

7Bila )SE100 mg4*l eri#an

$uga )10 500 66 2 t(m

7Target "enurunan lu#osa

)arah seesar 5075 mg4*l4$am

7)iet )' 1!00 ##al4hari

Ren6ana *iagnosti#:

)S (er $am

)" *an )""

HA16

)arah rutin

"ro,il li(i*

UrCr

/le#trolit

STS"T

Asam urat

Ren6ana tera(i:

Usul #onsul agian

(ulmonologi

Ren6ana )iagnosti#:

7Alumin

7"rotein total

7Ren6ana (un#si (leura

7"emeri#saan s(utum BTA 3gram *an $amur

7Ren6ana (emeri#saan @)H

serum *an (rotein total serum

7Ren6ana analisa 6airan (leura

7Ren6ana (emeri#saan

/6ho6ar*iogra(h-

Tera(i *ari TS Be*ah *igesti+:

7Ce,tria#son in$ 1 gr41 $am I=

7metroni*a;ole 500 mg48 $am

I=

7#etorola6 in$48 $am I=

7alan6e 6airan

7Ra%at @u#a

10727015

10.00/n*o#rin 'etaoli#

S:

@emas mual muntah Ri%a-at )' *ari tahun 003

Tera(i:

7Beri#an insulin *ri( sesuai(roto#ol


7/22

ri%a-at meng#onsumsi

glien6lami*

:

)S:182 mg4*l (#l

13.00

)S:2 mg4*l (#l

.00

I'T: 2 #g4m

A:

)iaetes mellitus ti(e non

oese

)S D 300 eri#an ! U4$am

)S 007300 eri#an 3 U4$am

)S 100700 eri#an 15

U4$am

7Bila )S E !0 sto( *ri(

insulin *an (eri#sa )S (er

$am


$uga )10 500 66 2 t(m

7Target "enurunan lu#osa

)arah seesar 5075 mg4*l4$am

7)iet )' 1!00 ##al4hari

11727015

0.00Interna

T):134!8 mmHg

N:8!4menit

R:04menit

S:3!!0C

Sa:98

Pe"awatan I&U ha"i !e*

1.)' ti(e non oese

S:

@emas mual muntah

:

HA16:91

)S:155 mg4*l


S:

Batu# sesa#

:

"aru:(er#usi re*u( (aru

ilateral setinggi ICS =II

3.Hi(oaluminemia

S:

&e*ua &a#i tam(a# eng#a#

:

"itting oe*em ?4?

Alumin:5 gr4*l

2.Hi(eruri6emia asim(tomati#

S:

N-eri sen*i ti*a# a*a

:Tan*a in,lamasi (a*a sen*i

Tera(i:

7*ri( insulin 15 U4$am


$uga )10 500 66 2 t(m

7Bila )S E !0 sto( *ri(

insulin *an (eri#sa )S (er

$am

7)iet )' 1!00 ##al4hari

7Target )S 1207180 mg4*l

Ren6ana )iagnosti#:

7&ontrol )S43 $am

Ren6ana Tera(i:

Usul #onsul agian

(ulmonologi

Tera(i:

7Alumin otol 0 *ri( 1

otol4hari

7=I" alumin #a(sul 3

Tera(i:

7Allo(urinol ta 100 mg 11

7)iet ren*ah (urin


8/22

'T"71 ti*a# a*a

Asam Urat:11 mg4*l

Cr:5 mg4*l

5.A&I (re renal Taha( I

))4A6ute on C&)

S:

Sesa#

:

Ur:100 mg4*l

Cr: 5 mg4*l

!.Anemia hi(o#rom mi#rositer

e6 6hroni6 *isease

))4*e,isiensi Fe

S:

@emas

:

&on$un6ti+a (u6at 747

@a:

H:109

'C= *an 'CH menurunRBC:23010! u4@

.Tumor Colon Trans+ersum


S:


:

=AS s6ore:5410

Ter(asang stoma

"eristalti# usus

Hasil @a:

BC:890 1100

Neutro,il:89 881

@/):

am I:19 mm4$am

am II:52 mm4$am

ST: U4@

S"T:21 U4@

@)H:328 U4@

"rotein total:53 gr4*l

H)@:! mg4*l

Tera(i:

7NaCl 09 500 66 8 t(m

7)iet ren*ah (rotein 08

g4&gBB4hari

7)iet ren*ah garam gr4hari

7)iet ren*ah (urin

7Usul #onsul H

7Balan6e 6airan

Ren6ana *iagnosti#:

7(emeri#saan urinalisa

Tera(i:

Atasi etiologi *asar

Ren6ana *iagnosti#:

7Ren6ana (emeri#saan

FeTIBC,erritine reti#ulosit

7Ren6ana (emeri#saan A)T




I=


7alan6e 6airan

7Ra%at @u#a


9/22

@)@:80 mg4*l

&olestrol total:1 mg4*l

Trigliseri*a:9! mg4*l

/le#trolit:

Na:121 mmol4@

&:51 mmol4@

Cl:113 mmol4@

11727015

0.00

/n*o#rin 'etaoli#

S:

@emas ri%a-at )'

:

)":155 mg4*l

)S malam 185 mg4*l

A:

)iaetes mellitus ti(e non

oese

Tera(i:

7Beri#an insulin *ri( sesuai

(roto#ol:

7Bila )SD300 mg4*l *ri(

insulin ! unit4$am

7Bila )S 007300 *ri( insulin

3 unit4$am

7Bila )S E00 *ri( insulin15 unit4$am

7Bila )S E100mg4*l

tamah#an )10 2 t(m

7Bila )S E !0 mg4*l sto( *ri(

insulin


10/22

0!.30

Interna

T):11242 mmHg

N:9!4menit

R:!4menit

S:3!20C

Sa:90

1.)iaetes 'ellitus ti(e non

oese

S:

"asien mengeluh lemas

:

)S:131 mg4*l


S:

Batu# sesa# :

"aru:(er#usi re*u( (aru

ilateral setinggi ICS =II

Foto thora:


3.Hi(oaluminemia

S:

&e*ua &a#i tam(a# eng#a#:

"itting oe*em 747

Alumin:5 gr4*l


S:


:

Tan*a in,lamasi (a*a sen*i

'T"71 ti*a# a*a

Asam Urat:11 mg4*l

Cr:5 mg4*l

5.A&I (re renal Taha( I

))4A6ute on C&)

S:

Sesa#

:

Ur:100 mg4*l

Cr: 5 mg4*l

Tera(i:

)iet )' 1!00 ##al4hari

*ri( insulin 15 U4$am

Bila )SE100 mg4*l eri#an

$uga )10 500 66 2 t(m

7&ontrol )S43 $am


insulin


11/22


e6 6hroni6 *isease

))4*e,isiensi Fe

S:

@emas (er*arahan ti*a# a*a

:


@a:

H:109 113

'C= *an 'CH menurun

RBC:23010! U4@ 2210!

U4@


(ost o( hemi6ole6tom- *etraS:


su*ah mulai er#urang

:

=AS s6ore:3410

Ter(asang stoma

"eristalti# usus

@a:

)S:131 mg4*lBC:1100 11130 u4@

Neutro,il:89 80

Tera(i:

Atasi etiologi *asar


7Ce,tria#son in$ 1 gr41 $am I=7metroni*a;ole 500 mg48 $am

I=


7alan6e 6airan

7Ra%at @u#a

1727015

0.00

/n*o#rin 'etaoli#

S:

(asien mengeluh lemas

:

)S:131 mg4*l

A:

)iaetes mellitus t-(e non

oese

Tera(i:




$uga )10 500 66 2 t(m

7&ontrol )S43 $am


insulin


12/22

Stoma:,eses hi$au (e#at

)S:130

A:

"ost o( hemi6ole6tom- hari #e7

)' ti(e

'etroni*a;ole 500 mg48 $am I=

Ren6ana *iagnosti#:

"eri#sa ele#trolit

Foto thora

1727015

13.00

"ulmonologi

S:

Sesa# ti*a# a*a atu# ti*a#

a*a *emam ti*a# a*a ri%a-at

AT ti*a# a*a ri%a-at

mero#o# ti*a# a*a ri%a-at

*iaetes a*a

:

Sa#it erat4gi;i 6u#u(4CS 15

T):1004!0HR:10

RR:304menit

Suhu:3!5

Sa:! *engan NR'

Anemis ti*a# a*a i#teri# ti*a#

a*a

=":R?1 6mH +esi#uler

*engan rhon#hi *i a(e un-i

na,as menurun *i hemithora

sinistra *an asal hemithora*etra e#stremitas:oe*em a*a

)R:

BC:11.00

H:109

T6:.000

)S:182 mg4*l

Foto thora:


A:

/,usi (leura ilateral et 6ausa

malignan6-

Tera(i:

7'eth-l(re*nisolon in$ 15

mg42 $am I=

7 10 @"' =ia NR'

Ren6ana *iagnosti#:

7Cito ,oto thora #ontrol

7Cito A)

7Ren6ana (un#si 6airan (leura7Ren6ana (emeri#saan US

7thora mar#er $i#a &U

memung#in#an

7Analisa *an sitologi 6airan

(leura

7/&

7"emeri#saan S(utum BTA 3

gram *an $amur

1727015

15.10

Be*ah *igesti,

S:

Sesa#

:

Sa0:!

Foto thora:

&esan:/,usi (leura masi,

A0. (,**+,-)

(H :.385

(C :32.2 mmHg

S :3." :25.1 mmHg

Tera(i:

7 10 @"' +ia NR'

7&onsul Cito agian e*ah

thora#s #ar*io+as#uler untu#

(emasangan 6hest tue


13/22

HC3 :0.8 mmol4@

B/ :72.5 mmol4@

&esan :Asi*osis metaoli#

ter#om(ensasi seagian

A:

"ost " la(arotom- e#s(lorasi

e6 tumor 6olon trans+ersum

/,usi (leura

1727015

1!.30

Be*ah Thora &ar*io+as#uler

S:

Sesa# er#urang

:

&U:se*ang

RR:84menit

Saturasi 82

Un*ulasi

A:/,usi (leura ilateral (ost

(emasangan 6hest tue

Tera(i:

7"emasangan 6hest tue

7Ta#ar (ro*u#si S) tia( 2

$am

13727015

0.15

Interna

T):11840 mmHg

N:84menit

R:4menit

S:3!!0C

Sa:9!

Pe"awatan ha"i !e8

1.)' ti(e non oese

S:

@emas a*an

:

)S:11 mg4*l

./,usi (leura ilateral

S:

Sesa#

:

S:9!

Ter(asang 6hest tue ilateral

BC:11.00

@/) I:19

@/) II:52

"rotein total:53

Un*ulasi

arna 6airan (leura er%arna

#uning #e6o#latan

"ro*u#si 6airan (aru #iri:100

66"ro*u#si 6airan (aru #anan:!00

Tera(i:




$uga )10 500 66 2 t(m

7&ontrol )S43 $am


insulin


14/22

66

3.Hi(oaluminemia

S:

&e*ua &a#i tam(a# eng#a#

:

"itting oe*em 747


S:


:

Tan*a in,lamasi (a*a sen*i

'T"71 ti*a# a*a

5.A&I (re renal Taha( I))4A6ute on C&)

S:

Sesa#

:

Ur:3 100

Cr:1 5


e6 *e,isiensi Fe ))46hroni6*isease

S:

@emas

:


@a:

H:109 113

'C= *an 'CH menurun

RBC:23010! U4@ 2210!

U4@



S:


su*ah mulai er#urang

:

=AS s6ore:3410

Ter(asang stoma

"eristalti# usus

Tera(i:

7Alumin otol 0 1

otol4hari

7=I" alumin #a(sul 3

Tera(i:

7Allo(urinol ta 100 mg 11

7)iet ren*ah (urin

Tera(i:7)iet ren*ah (rotein 08

g4&gBB4hari

7)iet ren*ah garam gr4hari

7)iet ren*ah (urin

7Balan6e 6airan

7#onsul H

Tera(i:

7Atasi etiologi *asar




I=


7alan6e 6airan

7Ra%at @u#a


15/22

13727015

0.00

/n*o#rin 'etaoli#

S:

Ri%a-at )' (asien

mengeluh lemas ila )SE125

mg4*l

:)S:11 mg4*l

)S er#isar antara 907180

mg4*l

A:

)iaetes mellitus t-(e non

oese

Tera(i:




$uga )10 500 66 2 t(m7&ontrol )S43 $am


insulin


16/22

Be*ah :

CS:/3=3'5:11

&U:lemah

CS: Sa:50

T):55431 mmHg

A:

tumor 6olon trans+ersum (ost

hemi6ole6tom- *etra

Tera(i lan$ut sesuai TS anestesi

13727015

1.25

Anestesi

S:

"enurunan #esa*aran

:

CS:/1'1=1

"u(il mi*riasis total

Tera(i:

7)ila#u#an R"

7agging

7/(ine,rin 01 mg45 menit

13727015

13.10

Anestesi

"asien *in-ata#an meniggal

*unia

Peme"i!saan Penun%an#:

Peme"i!saan &olon in Loo' (*+,-):

&esan:Tumor Colon trans+ersum (roimal

5asil Labo"ato"ium (,,*+,-)

@/):

am I :19 mm4$am

am II :52 mm4$am

ST : U4@S"T :21 U4@

@)H :328 U4@

"rotein total :5.3 gr4*l

Alumin :.5 gr4*l

HA16 :9.1

H)@ :! mg4*l

@)@ :80 mg4*l

&olestrol total :1 mg4*l

Trigliseri*a :9! mg4*l

Asam urat :11 mg4*lUreum :100 mg4*l

&reatinin :.5 mg4*l

A0. (,**+,-)

(H :.385

(C :32.2 mmHg

S :3.

" :25.1 mmHg

HC3 :0.8 mmol4@

B/ :72.5 mmol4@&esan :Asi*osis metaoli# ter#om(ensasi seagian


17/22

Kimia da"ah (,,*+,-)

Na :121 mmol4@

& :5.1 mmol4@

Cl :113 mmol4@

$oto Tho"a1 (2*+,-)

&esan:/,usi "leura Bilateral

Peme"i!saan 5emostasis (2*+,-):

CT :8

BT :3

"T :13.3

INR :1.0

A"TT :.1

Kimia da"ah (2*+,-):

)S:2 mg4*l

Peme"i!saan Imunose"olo#i (2*+,-)

HsAg :non rea#ti,

ST :3 U4@

S"T :38 U4@

Alumin :. gr4*l

)S :182 mg4*l

Ureum :3 mg4*l&reatinin :1. mg4*l

$oto Tho"a1 (,**+,-)

&esan:/,usi "leura 'asi,

.a"ah Rutin 2*+,- /*+,- ,,*+,- ,**+,-

BC 9290 890 1100 11130

RBC 2!110! 28010! 23010! 2210!

H 118 11 109 113

'C= 2! 5 !5 'CH 5! 5 53 53

Tromosit 2!000 !8000 000 98000

Neutro,il 3 89 881 80

NO

4

T#l

Peme"i!saan

9AM PEMERIKSAAN01.00 0.00 03.00 02.00 05.00 0!.00 0.00 08.00 09.00 10.00 11.00 1.00

1. 1727015 99 131 1!2 1

. 13727015 102 11 18 11813.00 12.00 15.00 1!.00 1.00 18.00 19.00 0.00 1.00 .00 3.00 2.00

1. 1727015 1!8 15 1 131 10

. 13727015 125 138 10 13


18/22

NO

4

T#l

Peme"i!saan

9AM PEMERIKSAAN01.00 0.00 03.00 02.00 05.00 0!.00 0.00 08.00 09.00 10.00 11.00 1.00

1. 10727015 22 1!2 18! 1

. 11727015 182 128 150 1!0 1!5 195 155 1!213.00 12.00 15.00 1!.00 1.00 18.00 19.00 0.00 1.00 .00 3.00 2.00

1. 10727015 182 00 305 25 !2 5 192 0 182 189 189

. 11727015 1 12 192 180

RESUME

@a#i7la#i 50 tahun *i#onsul #e agian /n*o#rin metaoli# *ari agian e*ah *igesti, *engan

#eluhan lemas a*an -ang ti*a# *isertai #eringat *ingin -ang *ialami hari tera#hir *engan

)S:2 mg4*l *an )":18 mg4*l *ari anamnesis leih lan$ut *i#etahui ah%a (asien memili#i

ri%a-at )' -ang su*ah *i*erita (asien se$a# tahun 003 meng#onsumsi glien#lami* namun

*i#onsumsi se6ara ti*a# teratur oleh (asien. "asien masu# rumah sa#it (a*a tanggal 8727015 *engan

ru$u#an *ari RSU) Bau7Bau *engan #eluhan sulit BAB *an (erut *irasa#an tam(a# memesar se$a#

minggu seelum masu# rumah sa#it mual *an muntah a*a. )ari hasil (emeri#saan Ra*iologi *i

RSU) Bau7Bau *i#ata#an (asien men*erita #an#er usus (asien telah men$alani o(erasi *i RSUH

(a*a tanggal 9727015. "asien $uga mengeluh atu# -ang ersi,at hilang timul *isertai *aha# -ang

er%arna $ernih *an #ental -ang su*ah erlangsung se$a# tahun tera#hir *isertai (enurunan erat

a*an *rastis se$a# ulan tera#hir *imana (asien turun 8 #g *alam ulan (asien memili#i ri%a-at

#eiasaan mero#o# se$a# usia mu*a *an rata7rata meng#onsumsi 17 ung#us4hari.

"a*a (emeri#saan ,isi# *i*a(at#an (asien tam(a# sa#it se*ang #esa*aran 6om(os mentis

CS 15


19/22

/,usi (leura a*alah suatu #ea*aan *imana ter$a*i (enum(u#an 6airan meleihi normal *i

*alam 6a+um (leura *iantara (leura (arietalis *an +is6eralis *a(at eru(a transu*at atau e#su*at.

"en-a#i7(en-a#it -ang *a(at menimul#an e,usi (leura a*alah tuer#ulosis in,e#si (aru non

tuer#ulosis #eganasan sirosis hati trauma in,ar# (aru serta gagal $antung #ongesti,. Ter*a(at

eera(a teori tentang timuln-a e,usi (leura (a*a neo(lasma -a#ni:menum(u#n-a sel7sel tumor

a#an mening#at#an (ermeailitas (leura terha*a( air *an (rotein a*an-a massa tumor menga#iat#an

tersumatn-a aliran (emuluh *arah +ena *an getah ening sehingga rongga (leura gagal *alam

memin*ah#an 6airan *an (rotein *an a*an-a massa tumor memuat in,e#si leih mu*ah ter$a*i *an

selan$utn-a timul hi(o(roteinemia. e,usi (leura *a(at $uga ter$a*i (a*a #ea*aan hi(oaluminemia

*imana e,usi ter$a*i #arena ren*ahn-a te#anan osmoti# (rotein 6airan (elura *ian*ing#an *engan

te#anan osmoti# *arah1 *imana (a*a (asien #ami men*uga -ang men$a*i (en-ea *ari e,usi (leura

(a*a (asien a*alah #arena #eganasan -ang ermetastasis #e (aru *an a*an-a

#on*isi hi(oaluminemia.(a*a (emeri#saan ,isi# (aru *itemu#an ta#til ,remitus *an +o#al ,remitus

-ang menurun serta suara na,as -ang melemah sam(ai menghilang (a*a agian (aru -ang mengalami

e,usi *an tra#ea -ang ter*orong #e #ontralateral.1 "a*a (emeri#saan ,isi# (aru -ang *ila#u#an (a*a

(asien *i*a(at#an (a*a ins(e#si (ergera#an rongga thora#s asimetris *imana (ergera#an (aru #iritertinggal (a*a (al(asi *i*a(at#an ta#til ,remitus -ang menurun (a*a (aru #iri setinggi ICS = *an

(aru #anan menurun setinggi ICS =I (a*a (er#usi *i*a(at#an (er#usi re*u( setinggi ICS = (a*a (aru

#iri *an (a*a (aru #anan setinggi ICS =I *engan suara na,as -ang melemah (a*a (aru #iri setinggi

ICS = *an (aru #anan setinggi ICS =I. Untu# #on,irmasi *ugaan a#an a*an-a e,usi (leura ma#a

mutla# *i(erlu#an (emeri#saan ,oto thora#s


20/22

seai#n-a "enari#an 6airan (a*a thora6o6entesis seai#n-a ti*a# meleihi 1 liter *imana (enari#an

6airan D 1715 liter *a(at men-ea#an ter$a*in-a re7e(ansion (ulmonar- oe*em. 3 &ami (i#ir#an

ter$a*i re7e(ansion (ulmonar- e*ema (a*a (asien #arena a*an-a ge$ala sesa# (a*a (asien -ang

*irasa#an tia7tia *an mun6ul *alam 2 $am *an a*an-a tan*a hi(o#semia *engan saturasi o#sigen

50 setelah *ila#u#an tin*a#an thora6entesis *engan (enari#an 6airan (a*a (aru #iri 100 66 *an

(a*a (aru #anan seesar !00 66. (enanganan umumn-a eru(a (enanganan su(orti, *engan

(emerian o#sigen *engan nonin+asi+e +entilation *an in+asi+e +entilation.2"a*a (asien *ila#u#an

(emasangan intuasi en*otra#eal untu# mengo(timal#an (emerian o#sigen.

)i(i#ir#an $uga #emung#inan lain -aitu ter$a*in-a mediastinal shift a#iat (engemangan

(aru -ang terlalu 6e(at sehingga ter$a*i (ene#anan (a*a aorta $antung *an (emuluh *arah esar

*alam ruang me*iastinum sehingga te$a*i (enurunan aliran *arah ali# *an ter$a*i (enurunan cardiac

output *ii#uti *engan ter$a*in-a (enurunan te#anan *arah -ang men-ea#an ter$a*in-a s-o#

#ar*iogeni#.8

/moli (aru meru(a#an #ea*aan ter$a*in-a ostru#si seagian atau total sir#ulasi arteri

(ulmonalis atau 6aang76aang a#iat tersang#utn-a emoli tromus atau emoli -ang lain. Fa#tor

(re*is(osisi ter$a*in-a emoli (aru menurut =ir6ho% 185! meli(uti 1>. A*an-a aliran *arah -ang

lamat >. &erusa#an *in*ing (emuluh *arah +ena *an 3>. &ea*aan *arah mu*ah meme#u

. Aliran *arah -ang lamat *a(at *itemu#an (a*a eera(a #ea*aan misaln-a

(a*a imoilitas tirah aring anestesi *an gagal $antung #ongesti,. )arah -ang mengalir lamat

memeri #esem(atan leih an-a# untu# meme#u . &erusa#an *in*ing (emuluh *arah

+ena *a(at ter$a*i (a*a #ea*aan misaln-a (a*a trauma *an (eme*ahan *imana #erusa#an en*otel

(emuluh +ena *a(at men-ea#an a#ti+asi (roses (eme#uan. &ea*aan *arah mu*ah meme#u $uga

meru(a#an ,a#tor (re*is(osisi ter$a*in-a tromus misaln-a (a*a #eganasan tromositosis essensial

*an (olisitemia +era."a*a (asien #ami memi#ir#an #emung#inan $uga ter$a*in-a emoli (aru #arena

a*an-a ,a#tor (re*is(osisi (a*a (asien -aitu a*an-a ri%a-at #eganasan (a*a (asien a*an-a ri%a-at(eme*ahan *an tirah aring serta immoilisasi (a*a (asien. &ami (i#ir#an (en-ea #ematian (a*a

(asien #arena ter$a*in-a re7e(ansion (ulmonar- e*ema *an #emung#inan emoli (aru -ang

men-ea#an ter$a*in-a gagal na,as sehingga men-ea#an #ematian (a*a (asien.


21/22

Ke"an#!a Konse':

DM Ca Colon

Transversu

Pembedahan

(kerusakan

Trombos

Resiko trombosis

meningkat

Tirah

baring

Hipoalbumine

Keganasan

(hiperkoagulab

Kematia

Gagal

a!as

Thora"o"en

tesis

#!usi

Pleura

$munit

as

T%&&

Mediastin

al Shift

Reexpansionpulmonary

oedem


22/22

.A$TAR PUSTAKA

1. Halim Ha*i. "en-a#it7(en-a#it "leura. )alam: Bu#u A$ar Ilmu "en-a#it )alam Su*o-o A

et al. /*isi =I ili* II. a#arta: "usat "eneritan I") F&UIG hal. 1!3171!39.. Rahmatullah "asi-an. Tromoemoli "aru. )alam: Bu#u A$ar Ilmu "en-a#it )alam Su*o-o

A et al. /*isi =I ili* II. a#arta: "usat "eneritan I") F&UIG hal. 1!9071!99.

3. Fau6i Anthon- S et al. Cha(ter 2: "ro6e*ures Commonl- "er,orme* - Internists

in:HarrisonJs "rin6i(le o, Internal 'e*i6ine 18th/*ition. USA:'6 ra%7Hill 013 3073.

2. Rahil &asmani ') Far;an I ') et al. Re7e(ansion (ulmonar- e*ema ,ollo%ing

thora6entesis. Cana*ian 'e*i6al Asso6iation ournal. No 18 . 010

5. Rasha AlKa*i ') Carolina F =alen6ia ') et al. Re7e(ansion (ulmonar- e*ema ,ollo%ing

thora6entesis. Rho*e Islan* 'e*i6al ournal. 013

!. /*uar*o HenriKue eno,re Fransis6o S =argas et al. Re7e(ansion (ulmonar- e*ema.

"neumol 003G 9:1017!.

. A(arna A#ella Shri(a* B )esh(an*e. "ulmonar- Sur,a6tants an* their role in

(atho(h-siolog- o, lung *isor*ers. In*ian ournal o, /(erimental Biolog- =ol. 51 anuar-

013 ((. 57

8. Hanle- 'i6hael / Carol-n H. elsh. Current Diagnosis & Treatment in Pulmonary

Medicine1ste*ition. '6ra%7Hill Coma(nies.USA:003. /7oo#

#mboli

S'ok

Kardiogeni

DC Tn Salim

Documents

Transcript of DC Tn Salim