Presus 1 HCC

7/25/2019 Presus 1 HCC

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AZIZAH RIDWAN

110.2009.050

PRESENTASI KASUS

Hepatocellular Carc!o"a e.c

Hepatt# $ Kro!%



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



ANAMNESIS

Keluhan Utama:

Ner perut %a!a! ata#



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-.



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 <*=.



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' <*=



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' <*=



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



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"#.



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



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- *>* /- *>*



"!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! & #! <*=



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=



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## <*>*=



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



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



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%



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.



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.



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%



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



PR!8N!SIS

Dua a4 "ala"



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!



DISKUSI



P)ANNIN



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

http://www.medicinenet.com/liver_cancer/page10.htm

http://www.nlm.nih.gov/medlineplus/ency/article/000280.htm

http://www.kalbe.co.id/files/cdk/files/08_150_HepatomaHepatorenal.pdf/08_150_HepatomaHepatorenal.html


http://emedicine.medscape.com/article/282814-overview

http://emedicine.medscape.com/article/282814-overview



http://www.nlm.nih.gov/medlineplus/ency/article/000280.htm

http://www.medicinenet.com/liver_cancer/page10.htm

Presus 1 HCC

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