Transcript
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TUMOR GASTERPRAJOGO KUSUMA
C111 11 157
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ANAMNESIS
Identitas:
Nama : Tn. LM
Jenis kelamin : Laki-laki
Usia : 54 a!"n
N#m#$ RM : 7%%&'&
Tan((al mas"k: %4-&-%)15
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Kel"!an "ama: M"na! *e$+am,"$ a$a!
Ria/a ,en/aki seka$an(: 0ialami seak k"$an( le*i! % *"lan/an( lal" se*el"m mas"k $"ma! saki. M"na! a$a! ,e$ama kai$asakan seak ' *"lan /an( lal" kem"ian *e$!eni. M"al aa.Pasien "(a men(el"! ,e$" /an( +e,a e$asa ,en"! *ila makanan min"m. Ria/a n/e$i ,e$" aa i *a(ian ki$i aas saa
*e$aki2ias m"n+"l ,e$ama kali seak ' *"lan /an( lal". Pasienmen(el"!kan $asa ,en"! i,e$" /an( mem*"a na3s" makann/a*e$k"$an(. Ria/a +e,a ken/an( aa. Saa ini ,asien masi! *ismakan seiki-seiki. Ria/a ,en"$"nan *e$a *aan sekia$ 7 kseak ' *"lan /an( lal". Ria/a men(k#ns"msi makanan /an(iasinkan aa" i*aka$ kaan(-kaan(.
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Pasien "(a men(el"! A *e$+am,"$ a$a! aa" ke!iaman a *"lan /an( lal". Ria/a s"sa! A iak aa. Ria/a Ase,e$i k##$an kam*in( iak aa. "an( ai$ ke+il : lan+a$6 a$nk"nin(
Riwayat Penyakit Sebelumnya:
Ria/a me$#k#k aa sekia$ 1) a!"n /an( lal"
Ria/a k#ns"msi alk#!#l aa sekia$ 1) a!"n /an( lal"
Ria/a !i,e$ensi iak aa
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PEMERIKSAAN FISIK
Sa"s (ene$alis
Sa"s (ene$alis : saki sean( (i8i +"k", +#m,#s menis
Sa"s 2ialis : Tekanan a$a! 1)9) mm(
Nai 9) kalimeni
Pe$na,asan %) kalimeni
S"!" '6&# C
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Sa"s Gene$alis
Kepala :
Ram*": iam6 iak m"a! $#n#k.
Maa : Eks#3alm"s ;-<
Leak : Sime$is
Pe$(e$akan : 0alam *aas n#$mal
Pal,e*$a : Eema ;-<
K#$nea : Je$ni!
P",il : "la6 is#k#$
Skle$a : Tiak ike$ik
K#n"n(i2a : Anemis
Telin(a : Sime$is6 iak e$a,a se$"men
i"n( : Pe$na3asan +",in( !i"n( : ;-<
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Bibir : Sian#sis ;-<
M"l" : G"si iak !i,e$emis
Lia! : *e$si!
T#nsil : T1T1
=a$in( : iak !i,e$emis
Leher :
>ns,eksi : Kelena$ i$#i iak am,ak mem*esa$
Pal,asi : Kelena$ i$#i iak e$a*a ,em*esa$an
J?P : R@% +m%O
KG : Tiak e$a*a ,em*esa$an kelena$ s",$a+la2i+"la
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h!raks
Paru
>ns,eksi : en"k an ,e$(e$akan ,e$na3asan kanan an ki$isime$is
Pal,asi : =$emi"s akil sime$is kananki$i
Pe$k"si : S#n#$ ,aa ke"a la,an( ,a$"
A"sk"lasi : S"a$a na3as 2esik"le$ ,aa sel"$"! la,an(an ,a$"6!ee8in( ;--<6 $#nk!i ;--<
KG : Tiak e$a*a ,em*esa$an kelena$ aBilla
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"antun#
>ns,eksi :>+"s +#$is iak e$li!a
Pal,asi :>+"s +#$is iak e$a*a.
Pe$k"si :aas aas sela i(a >>> (a$is mi kla2ik"la ki$i
aas kanan sela i(a ? (a$is se$nal kanan
aas ki$i sela i(a ? (a$is miaBilla$is ki$i
A"sk"lasi :"n/i an"n( > >> m"$ni6 $e("le$6 m"$m"$ ;-<6 (all#;-<
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Re#i! Abd!men
>ns,eksi : Pe$" aa$6 iak am,ak massa "m#$6 a$m sei3"n( ;-<6a$m+#n#"$;-<
A"sk"las i: isin( "s"s ;@<6 kesan n#$mal
Pal,asi : iak e$a*a massa6 n/e$i ekan ;@<
Pe$k"si : Tim,ani6 ,ekak ,aa a*#men D"a$an ki$i aas
KG : Tiak e$a*a ,em*esa$an kelena$ i "m*ili+"s an i ,el2is
Re$tal !u$her :
Sn(e$ Men+ekik
M"k#sa Li+in
Am,"lla Te$isi =eses
ans+#en : =eses aa6 a$a! iak aa6 leni$ iak aa
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Peme$iksaan ,en"nan(
0a$a! $"in ;!asil ,aa an((al 19 Se,em*e$ %)15<
RC : 5.)7 B 1)' "L
* : 11.% (L
FC : 4.99 B 1) "L
: '.9
Pl : 44%)))HL
SGOT : %
SGPT : 17
G0S : 99
Al*"min: 4.)
U$e"m : 19
K$eainin: 1.))
s A(: N#n $eaki3
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Oes#,!a(#($a,!/
K#n$as *a$i"m imas"kkan se+a$a #$al
Tam,ak k#n$as men(isi es#,!a("s en(an
lan+a$6 +ali*e$ es#,!a("s alam *aas
n#$mal6 m"k#sa (ase$ iak am,ak llin(
e3e+
Kesan: #es#,!a(#($a,!/ alam
*aas n#$mal
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Maa( "#en#($a,!/
K#n$as *a$i"m se*an/ak %)) ++ imas"kkan
se+a$a #$al
0en(an I"#$#s+#,e am,ak k#n$as men(isi
en(an lan+a$ 3"n"s6 +#$,"s6 an$"m6 ,/l#$"s
(ase$6 "#eni.
M"k#sa $e("ke$ iak am,ak llin( e3e+ anaii#nal s!a#
Kesan: Maa( "#en#($a,!/ alam *aas
n#$mal
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asil Peme$iksaan UG>E
Sk#, mas"k sam,ai se+#n ,a$ "#en"m.
Pe$sia,an en#sk#,i *aik ;9)<. O$#3a$in( iak am,ak kelainan Es#3a("s : M"k#sa an LES am,ak *aik
Lam*"n( : i"m,ai massa "m#$ i k#$,"s ;k"$2a"$a ma/#$<
4B5 +m6 ,e$m"kaan "m#$ am,ak % "lk"s /an(
men((a"n(6 $a,"!6 an m"a! *e$a$a!.
M"k#sa an$"m am,ak "em6 e$iem6 en(an eks"a ;@<.
Pil#$"s inak
0"#een"m : *"l*"s m"k#sa am,ak n#$mal. Se+#n ,a$ ,a,illa 2ae$i
am,ak *aik
i#,si : massa "m#$6 an$"m
Kesim,"lan : - "m#$ lam*"n(
- An$al (as$iis s",e$sial ($ae %
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& 'h!le Abd!men tanpaK!ntras
Tam,ak lesi is#ens ; U< *aas e(as6 e,i $e("la$6 en(an "k"$an 965 B '67 +m ,aa k"$2a"$ama/#$ a$ea +#$,"s /an( men(inl$asi la,isan (ase$
Tiak am,ak ,em*esa$an kelena$ (ea! *enin( ,a$aa#$a a*#minalis
e,a$ : Uk"$an an ensias ,a$enkim alam *aas n#$mal. Tiak am,ak ilaasi 2as+"la$ ma","n*ile "+ in$aeks$a !e,ai+
G : 0inin( iak mene*al6 iak am,ak ensias *a".
Pank$eas : Uk"$an an ensias alam *aas n#$mal. Tiak am,ak ilaasi "+"s ,an+$eai+"s. Tiam,ak mass+/slesi ,a#l#(ik lainn/a.
Lien : Uk"$an an ensias alam *aas n#$mal. Tiak am,ak mass+/sn#"l measasis
Ke"a Ginal : Uk"$an an ensias ,a$enkim alam *aas n#$mal. Tiak am,ak ilaasi PCS. Tiakam,ak ensias *a"mass+/s
?U : inin( iak mene*al6 m"k#sa $e("la$. Tiak am,ak ensias *a"mass
Tam,ak kalsikasi ,aa a#$a a*#minalis ;a!e$#s+le$#sis<
Tiak am,ak ilaasi L##,-l##, "s"s
T"lan(-"lan( inak
Kesan : Massa Gase$
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(asil Pat!l!#i Anat!mi:
Mak$#sk#,ik : 0ie$ima 1 *"a! a$in(an "k"$an 1& B %) B & +m s"a! e$*ela!am,ak massa "m#$ alam l"men6 masas "m#$ & B & B & +m ,"i!6 ,aa ke$as
se,e$i "lan(
T"m#$
T"m#$
Ja$in(an i T"m#$
Mik$#sk#,ik: A an . Seiaan a$in(an "m#$ men"n"kkan ,$#li3e$asi sel inis,inle en(an ini /an( san(a sel"le$6 !i,e$k$#maik6 seiki ,iel#m#$k6 en(ami#sis /an( +"k", *an/ak6 nek$#sis minimal. T"m#$ iak *e$*aas e(as.
C. Seiaan a$in(an "m#$ an a$in(an lemak6 ,em*"l"! a$a!6 iak aa sa$an(
"m#$.
Kesan: Mali(nan Gis
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Res"me
Pasien laki-laki "sia 54 a!"n aan( ke RS Fa!iin S"i$#!"s## en(akel"!an m"na! a$a!. M"na! a$a! ialami seak k"$an( le*i! % *"lan/an( lal" se*el"m mas"k $"ma! saki. M"na! a$a! ,e$ama kalii$asakan seak ' *"lan /an( lal" kem"ian *e$!eni. M"al aa. Pasien
"(a men(el"! ,e$" /an( +e,a e$asa ,en"! *ila makan an min"m.Ria/a n/e$i ,e$" aa i *a(ian ki$i aas saa *e$aki2ias m"n+"l,e$ama kali seak ' *"lan /an( lal". Pasien men(el"!kan $asa ,en"!i,e$" /an( mem*"a na3s" makann/a *e$k"$an(. Ria/a +e,a
ken/an( aa. Saa ini ,asien masi! *isa makan seiki-seiki. Ria/a,en"$"nan *e$a *aan sekia$ 7 k( seak ' *"lan /an( lal". Ria/amen(k#ns"msi makanan /an( iasinkan aa" i*aka$ kaan(-kaan(.Ria/a emam iak aa. Ria/a sesak iak aa. Ria/a ,en/akien(an kel"!an /an( sama iak aa6 Ria/a ,en/aki !i,e$ensi ania*ees melli"s isan(kal.
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Paa ,eme$iksaan sis iem"kan ekanan a$a!: 1)9) mm(nai:9) Bmeni6 ,e$na,asan : %) B meni6 S"!" ;aBilla< : '6&# C6 GCS 15 ;E4M'?5<. Paa ,eme$iksaan $e(i#n a*#men6ia,akan n/e$i ekan ,aa a*#men $e(i# D"a$an ki$i aas.
asil ,eme$iksaan $e+al #"+!e$ ia,akan sn(e$ men+ekik6m"k#sa li+in6 am,"lla e$isi 3eses. ans+!#en6 3eses aa6 leni$an a$a! iak aa.
0ia(n#sis Ke$a: T"m#$ Gase$
Ren+ana Penaalaksanaan: Ren+ana #al (as$e+#mi
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0a$i !asil anamnesis6 ,eme$iksaan sik an ,eme$iksaanla*#$a#$i"m ,asien iia(n#sa se*a(ai T"m#$ Gase$. T"m#$(ase$ aala! "m#$ /an( e$ai ,aa lam*"n( /an( a,aiia(n#sis melal"i anamnesis6 ,eme$iksaan sik6 $ai#l#(i6en#sk#,i an *i#,si. T"m#$ (ase$ a,a e$ai aki*a ie6in3eksi6 $as6 an (as$iis k$#nik. Penaalaksanaan "m#$ (ase$e$i$i a$i ,em*ea!an6 kem#e$a,i6 an $ai#e$a,i.
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E,iemi#l#(i
>nsien /an( in((i iem"kan i Cina6 Je,an(6 an C!ili.
0i Je,an(6 insien men+a,ai 7) ,e$ 1)).))).
0i E$#,a en(a! 4) ,e$ 1)).)))6 sean(kan i Ame$ika insien,aa lelaki 1) ,e$ 1)).))) ,#,"lasi ,e$a!"n.
Ja$an( iem"kan ,aa kel#m,#k "sia i*aa! 4) a!"n6 $esik#menin(ka en(an menin(kan/a "m"$. >nsien e$in((i ,aa
ekae ke '.
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Ana#mi
Me$",akan sal"$an ,en+e$naan seela! #es#,!a("s *e$3"n(si"n"k men+e$na *#l"s se+a$a mekanik men(("nakan (e$ak,e$isalik (ase$ an kimiai.
0inin( lam*"n( memiliki 5 la,isan :
1. m"k#sa.
%. s"*m"k#sa.
. Propria muskularis
4. s"*se$#sa
5. se$#sa *a(ian l"a$
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=isi#l#(i
E,iel lam*"n( mem,"n/ai 4 enis sek$esi /ai" +ai$an m"+"s6asam lam*"n( ;CL<6 en8im ,$#ease ;,e,sin#(en< an !#$m#n;(as$in<
Kenali ,aa ,en(#s#n(an lam*"n(:
Pen(#s#n(an isim"lasi se+a$a $eIeks saa me$es,#ns e$!aa,,e$e(an(an lam*"n(6 ,ele,asan (as$in6 kekenalan kim"s an eni
makanan. Pen(#s#n(an lam*"n( i!am*a #le! !#$m#n "#en"m /an( "(a
men(!am*a sek$esi lam*"n( an $eIeks "m,an *alik ene$#(as$ia$i "#en"m.
Sin/al "m,an *aik mem"n(kinkan kim"s memas"ki "s"s !al"s ,aake+e,aan e$en" se!in((a a,a i,$#ses.
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Fakt!r Resik!
0ie >n3eksi
e$eie$ an $as
Anemia ,e$nisi#sa
Reseksi (ase$ se*el"mn/a
0/s,lasia m"k#sa (ase$
P#li, (ase$
Gas$iis k$#nik
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0ia(n#sis
Anamnesis Kel"!an "ama ka$sin#ma (ase$ aala!: e$a *aan men"$"n6
n/e$i e,i(as$i"m6 m"na!6 kel"!an ,en+e$naan6 an#$eksia6is3a(ia6 na"sea6 malaise6 !emaemesis6 $e("$(iasi an lekasken/an(
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Peme$iksaan sis Peme$iksan sis a,a mem*an" ia(n#sis *e$",a *e$a *aan
men"$"n an anemia. 0i ae$a! e,i(as$i"m m"n(kin iem"kas"a" massa an ika ela! e$ai measasis ke !ai6 e$a*a !a/an( i$e("le$ an kaan(-kaan( kelena$ lim3e kla2ik"la e$a*aAan/a n/e$i ,e$"6 !e,a#me(ali6 asies6 kelena$ lim3es"*kla2ik"le$ ki$i ;Limfonodi Virchow)
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Rai#l#(ik Peme$iksaan $ai#l#(ik /an( ,enin( aala! ,eme$iksaan
k#n$as. 0i+"$i(ai aan/a ke(anasan *ila iem"kan e3#$mias6"kak6 aa" #n#lan i l"men
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Gas$#sk#,i en(an *i#,si m"li,le an ,eme$iksaan si#l#(ie$!aa, *a!an sikaan "kak i,e$l"kan "n"k memasikania(n#sis.
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En#sk#,i mem"n(kinkan 2is"alisasi lan(s"n( l#kasi "m#$6eksensi kee$li*aan m"k#sa an *i#,si "n"k ia(n#sis
a$in(an. Peme$iksaan lain aala!: en#sk#,i "l$as#"n ;EUS</an( a,a menen"kan staging "m#$ se+a$a le*i! ak"$a #le!ka$ena a,a meli!a kealaman in2asi "m#$ an menilai,e$l"asan eksensi kelena$ (ea! *enin( ,e$i(as$ika
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CT i("nakan ,$e#,e$asi e$"ama "n"k menen"kan,en/e*a$an a!a, an eB$a(as$i+ a$i s"a" ka$sin#malam*"n(. Selain i"6 CT i("nakan "n"k memana" an((a,an,asien e$!aa, ,en(#*aan. MR> "n(("l alam menilai !ai6"lan(6 an ,en/e*a$an ,e$i#ni"m
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Paa "m#$ (anas (ase$ se$in( ia,akan ,e$a$a!an alamina (occult bleeding)6 "n"k i" ,e$l" ilak"kan es *en8iine
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Jenis T"m#$ Gase$
Aen#+a$+in#ma L/m,!#ma
Gas$#inesinal s$#mal "m#$
Ca$+in#i "m#$
O!e$ +an+e$s
SD"am#"s +ell +a$+in#ma Small +ell +a$+in#ma
lei#m/#sa$+#ma
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Ke$a(aman is#,a#l#(i
Ka$sin#ma lam*"n( *e$asal a$i ,e$"*a!an e,iel ,aamem*$an m"k#sa (ase$6 /an( *e$kem*an( ,aa *a(ian *aa(ase$6 sean(kan ,aa a$# (ase$ ia,akan *a(ian aas
(ase$ an se+a$a m"lisene$. Aa *e$*a(ai *en"kaen#ka$sin#ma lam*"n(6 *en"k /an( se$in( iem"kan e$i$
a$i :
Ka$sin#ma Ulceratif
Ka$sin#ma Polipoid
Ka$sin#ma inltratif
Klasi)kasi
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Klasi)kasi
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P$#(n#sis
5-year surial "n"k aen#+a$+in#ma (ase$ ela! menin(kaa$i 15 sam,ai %% i Ame$ika Se$ika ,aa %5 a!"n e$ak!i$.S"$2i2al *e$(an"n( ,aa sai"m ,a!#l#(is ;sai"m TNM< ae$aa a$i i3e$ensiasi "m#$.
SA,E - .EARS/BSER0E*S1R0I0AL
STAGE >A 71
STAGE > 57
STAGE >>A 4'
STAGE >>
STAGE>>>A
%)
STAGE
>>>
14
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TER>MA KAS>
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