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Oleh :
Septiani Orthi Armelia
(2011730097)
Pembimbing : Dr. Gatot Sugiharto Sp!
Sta"e !e#ah $S%D Se&ar'angi
%*+
,aporan a"u"Peritoniti"
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-#entita" Pa"ienama : An. S/ +eni" &elamin : ,a&ila&i
%"ia : 12 tahun
Alamat : i"aat anggal : 17 oember 2014
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eluhan %tama5eri #i "eluruh bagian perut "e6a& 1 hari
S*$S
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$i'a5at Pen5a&it Se&arangPa"ien #atang &e rumah "a&it #engan &eluhan n5eri
#i "eluruh bagian perut "e6a& 1 hari S*$S. 5eri#ira"a&an teru" meneru" #an "ema&in "a&it 6i&abergera&. Selain itu perut tera"a &era" #an&embung. Pa"ien mual #an muntah "etiap "ele"aima&an muntah beri"i ma&anan 8 gela" auanamun muntah tera&hir ber'arna hi6au. Pa"ien 6ugamengeluh #emam #an !A! air ;10< len#ir ()#arah () #alam 12 6am tera&hir. Pa#ahal #alam =
hari tera&hir pa"ien ti#a& bi"a !A! #an &entut.Pa"ien memili&i ri'a5at 6atuh #ari pohon 1 minggu
S*$S #an bagian anu"n5a tertu"u& ranting pohon.
=
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$i'a5at Pen5a&it DahuluPa"ien belum pernah mengalami &eluhan "erupa
"ebelumn5a
$i'a5at Pen5a&it eluargaeluhan 5ang "ama #i &eluarga #i"ang&al
$i'a5at Pengobatan!elum pernah berobat "ebelumn5a
$i'a5at AlergiAlergi obat #i"ang&al
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Pemeri&"aan i"i&ea#aan %mum : ampa& "a&it "e#ange"a#aran : ompo"menti"
an#a >ital :
a#i : 11? <@menitSuhu : 37.4
Pernapa"an : 2= <@menit
e&anan #arah : 110@70 mmBg
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Statu" Generali"epala : normohepal*ata : &on6ungtia anemi" @
"&lera i&teri& @ pupil bulati"o&or reCe&" aha5a @
Bi#ung : "e&ret @
elinga : normotia "e&ret ()
*ulut : hiperemi" () anemi" () &ering
,eher : ti#a& a#a pembe"aran &elen6argetah bening #an tiroi#
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E
BO$AFParu-n"pe&"i : normohe"t pergera&an #a#a "imetri"Palpa"i : ti#a& a#a pergera&an #a#a 5ang
tertinggal n5eri te&an () o&al remitu" "imetri"
Per&u"i : "onor #i "eluruh lapang paruAu"&ulta"i : e"i&ular (@) ron&hi (@)'heeHing (@)
+antung-n"pe&"i : itu" or#i" ti#a& terlihatPalpa"i : itu" or#i" teraba #i -S 4 mi#laiula
"ini"traPer&u"i : bata" 6antung relati #alam bata"normal
Au"&ulta"i : bun5i 6antung - #an -- regularmurmur () gallop ()
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Ab#omen-n"pe&"i: Di"ten"i ab#omen () #een"e mu"ular
()
Au"&ulta"i : !i"ing u"u" 2<@menit
Per&u"i : impaniPalpa"i : 5eri te&an "eluruh &ua#ran ab#omen
() ti#a& a#a pembe"aran hepar #an "pleen
I&"tremita"
Superior : A&ral #ingin $ J 2 #eti& e#ema(). Siano"i" ()e#ema ()
-nerior : A&ral #ingin $ J 2 #eti& e#ema ().Siano"i" ()e#ema ()
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Pemeri&"aan retal touher : onu" otot bai&
*u&o"a liin
*a""a ()
5eri ()
er#apat ee" () #arah () len#ir ()
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Statu" ,o&ali"
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Statu" lo&ali" et regio ab#omen-n"pe&"iDi"ten"i ab#omen () #een"e mu"ular ()
Au"&ulta"i!i"ing u"u" menurun (2<@menit)
Per&u"i impani #i "eluruh regio ab#omen
Palpa"i5eri te&an #i "eluruh ab#omen
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$e"ume
,a&ila&i 12 tahun n5eri #i "eluruh bagian perut"e6a& 1 hari S*$S. Perut tera"a &era" #an &embung.au"ea () omitu" () ebri" () #iare ().
Sebelumn5a ti#a& bi"a !A! #an Catu". *emili&iri'a5at 6atuh #ari pohon #engan bagian anu"n5atertu"u& ranting pohon.
Pa#a pemeri&"aan K"i& #i#apat&an tan#a ital : na#i
11?<@menit "uhu 37.4 Pernapa"an 2= <@menitte&anan #arah 110@70 mmBg. Pa#a pemeri&"aanab#omen #i#apat&an a#an5a #i"ten"i ab#omen#ean" mu"ular n5eri te&an #i "eluruh regio
ab#omen !% menurun.12
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DiLerential Diagno"i"Peritoniti" e.. perora"i re&tumPeritoniti" e.. t5phoi# perora"i
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Penatala&"anaan
1=
Pemeri&"aan laboratorium : hematologi rutinele&trolit 'i#al
oto thora< M oto polo" ab#omen 3 po"i"i
$e"u"ita"i airan $, 20 tpmPua"a&anG #e&ompre"iD
arma&ologi$aniti#ine 2 < 0.24 mg*etroni#aHole 3 < 400 mg
-nteren"i operatie : ,aparotomi I&"plora"i
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Pemeriksaan Hasil Nilai Rujukan Satuan
HEMATOLOGI LENGKAP
Hemoglobin 1=.2 13.417.4 g@#,
Hematokrit 30.2 =242 N
Eritrosit 2.77 =.7?.1 10?@,
Leukosit 9.= =.E10.E 103@,
Trombosit 223 140=40 103@,
MC 10E.9 E09= ,
MCH 41.3 2731 pg
MCHC =7.1 3337 N
R!"#S! 1=2.E 374= ,
P!" 17.7 91= ,
MP 12.E E12 ,
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1?
Pemeriksaan Hasil Nilai Rujukan Satuan
!I$$ERENTIAL
L%M & 3.3 2? Q 3? N
M'! & 3.= 0 Q 11 N
NE( & 91.9 =0 Q 70 N
EOS & 1.2 1 Q 3 N
)AS & 0.2 J 1 N
A)SOL(T
L%M * 0.32 1.00 Q 1.=3 103@,
M'! * 0.33 0 Q 1.2 103@,
NE( * E.?2 1.E Q 7.? 103@,
EOS * 0.11 0.02 Q 0.40 103@,
)AS * 0.01 0.00 Q 0.10 103@,
Pemeriksaan Hasil Nilai Rujukan Satuan
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Pemeriksaan Hasil Nilai Rujukan Satuan
KIMIA KLINIK
Glukosa !ara+ Puasa 74 70110 mgN
Natrium ,Na- 12E.9 1341=E mI@,
Kalium ,K- 2.93 3.404.30 mI@,
Cal.ium Ion 0.?1 1.141.29 mmol@,
AST ,SGOT- 20 1437 %@,
ALT ,SGPT- 1E 127E %@,
(reum 47.? 1040 mgN
Kreatinin 0.7 01.0 mgN
IM(NOSEROLOGI
HbsAg on reatie on reatie
"i/al ,Salmonella
T01+i # O-
egati egati
"i/al ,Salmonella
T01+i # H-
egati egati
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Pemeri&"aan $ontgen
1E
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-nterpreta"i
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Preperitoneal at ti#a& 6ela". ontur &e#ua gin6alti#a& 6ela". P"oa" line ti#a& 6ela". i#a& tampa&&on&remen opa&. Di"tribu"i u#ara #alam u"u" halu"berlebih #engan penebalan "ebagian #in#ingn5amembentu& gambaran herring bone. Di"tribu"i u#ara
#alam &olon normal. Air Cui# leel () "tep la##erpa#a po"i"i ,,D ree air "ub#iaragma (). S&eletal5ang tere&"po"e ti#a& tampa& o"teoKt.
e"an : *en5o&ong ileu" ob"tru&ti leta& tinggipneumoperitoneum
or pulmo pleura "&eletal tampa& normale"an : *en5o&ong a#an5a pneumoperitoneum
#itan#ai ba5angan u#ara "ub#iaragma bilateral
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in6auan Pu"ta&a
Peritoniti"
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Din#ing Ab#omen
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+anuar5 E 201? %*+ $S%D -A+%$23
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Peritoneum
2=
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+anuar5 E 201? %*+ $S%D -A+%$24
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DeKni"i Peritoniti"
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la"iK&a"i Peritoniti"
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Itiologi Peritoniti"
2E
Area Sumber Penyebab
Esofagus Keganasan, trauma, iatrogenik
Lambung Perforasi ulkus peptikum, keganasan, trauma, iatrogenik
Duodenum Perforasi ulkus peptikum, trauma (tumpul dan
penetrasi) iatrogenik
Traktus bilier Kolesistitis, perforasi batu dari kandung empedu,keganasan, kista duktus koledokus, trauma, iatrogenik
Pankreas Pankreatitis, trauma, iatrogenik
Kolon asendens Iskemia kolon, hernia inkarserata, obstruksi loop,
penyakit Crohn, keganasan, Diertikulum !e"kel,
trauma
Kolon desendens dan apendiks Iskemia kolon, diertikulitis, keganasan, kolitis ulseratif
dan penyakit Crohn, apendisitis, olulus kolon, trauma,
iatrogenik
#alping uterus dan oarium Pelvic inflammatory disease, k eganasan, trauma
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Ge6ala lini" Peritoniti"
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Pemeri&"aan Penun6angPeritoniti"Pemeri&"aan #arah : leu&o"ito"i" "hit to
the let
%rine : ureum &reatinin
Fra5 :oto thora&" PA@lateral ; u#ara beba" #i
lobu" inerior
oto polo" ab#omen ; a"ite" tan#atan#aob"tru&"i u"u" berupa airCui# leel #an&a#ang&a#ang u#ara beba"
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Penatala&"anaan Peritoniti"
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Datar Pu"ta&a
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o'"en# *. +r #&&. Sabiston textbook ofSurgery . Il"iier. %nite# State o Ameria.200E
ole et al. 1970. Cole and Zollinger textbook
of Surgery 9th edition. Appeltonentur5 orpaui et al. 200E Borri"on" Prinipal o
-nternal *e#iine >olume 1 *Gra' hill.
!runiar#i . harle" #&&. Schwartz’s
Principles of Surgery Eight Edition.Tinner *. D&&. Abdoinal !perations tenth
editions. %nite# State" o Ameria. 1997.
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