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“ GOSH… Mrs.DOUBTFIRE… YOU LOOK
PALE “CASE 1A
BY : GROUP 3 TUTOR : DR. KUMALA DEWIBLOCK : GASTROINTESTINAL
FACULTY OF MEDICINE TARUMANAGARA UNIVERSITYAUGUST !"#$ %%&
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NIM NAME
'%(%)%%(1 ERIK ADITYA
'%(%)%%(* RIODIAN S
'%(%)%%* FORSALINA T
'%(%)%%*3 ALINE C LEADER
'%(%)%%** MAILAN +'%(%)%1! SUSANTI L SCRIBER
'%(%)%1& ANDRUW T
'%(%)%13' GRISELDA T SECRETARY
'%(%)%1'! HOSANA T
'%(%)%1(3 DANIEL ,
'%(%)%1*3 EMELIA W
'%(%)%1*' ANNASTA P
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“ GOSH… Mrs. D-/"0r… Y-L--2 P4 “
• W#54 6- 7r 7"8#59 “Hrr6 P-""r 9; T# G-/4" -< F5r= 59 TV ""# >r986 ;?r">9" 6- 7-r2;
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ANATOM Y OF GIT
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• UPPER GASTROINTESTINAL TRACT:
Es-?#sGs"rD-;9>Pr-5>4 +9>Tr5" 45>9"
• LOWER GASTROINTESTINAL TRACT:
Tr5" 45>9"D5s"4 +9>I4>C-4-9A9s
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HYPOACTIVE BOWELSOUNDS
• rs4" ;8rs; ?r5s"4s5s$ 7#58#$59 "r9$ 89 rs4" ;4-?59/-74 -/s"r8"5-9 9; "# s -< 8r"59
;rs$ /;->594 srr6$ 9; r;5"5-9"#r?6.
• T# -/s"r8"5-9: – >8#9584 s #r95$ ">-r
–s84r s 9 >/-45s> -r "#r->/-s5s
– 9r-958 s >8#9584$ 5s8#>58$ -r"-58 5>?5r>9" -< /-74 599r"5-9
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SYNDROME OF DYSPEPSIA
• ?rs5s"9" -r r8rr9" ??r/;->594 ?59 -r ;5s8->
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SYNDROME OF DYSPEPSIA
• E?5;>5-4-6: E8# 6r 1%% -< US?-?4"5-9 s2s >;584 ""9"5-9.NUD 3 ??"58 48r ;5ss.
• E"5-4-6 J P"#-9s5s:I>/498 -< "# r"59
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AGGRAVATING FACTORS OFSYNDROME DYSPEPSIA:
• Gs"r58 85;• P?s59• H458-/8"r ?64-r5 59-"-r 8"55"6: ((% ?"59"s #5/5" ?-s"?r9;54
9"r4 #6?->-"545"6 -r ;46; s"r58 >?"659• Ps68#-4-584 -259"-/88-$ 48-#-4• Drs: 9-9s"r-5;4 9"559>>"-r6 ;rs9s5;$
"r;5"5-94 ?59 2544r ;rs$ s"r-5;s$9"5/5-"58sr6"#r->6859$ >?5854459$ 5r-9$ ?-"ss5>$;5-59$ "#-?#64459.
• M"/-458 ;5sss: ;5/"s >445"s$ #6?-"#-r-5;5s>• H6?-?-"ss>5.• Fr r;584s
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DEFENSIVE FACTORS OFSYNDROME DYSPEPSIA:
• Pr-s"49;59
• M8s
• M8-s4 /4--; -7
• Sr
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CLINICAL FEATURES INSYNDROME DYSPEPSIA
• N-9 U48r D5ss: – U48r 452: ;->599" ?5s"r58 ?59$ r45;
/6 9"85;s -r -"545"6 452: ?5s"r58 ;5s8->s ;-s 9-" 0" "# -"#r8"-r5s
– R 452: #r"/r9 9; rr5""5-9
• U48r: "# s> 75"# NUD
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PHYSICAL EAMINATION INSYNDROME DYSPEPSIA
• 9-" s?8508
• ?5s"r58 "9;r9ss s-> "5>s
•
/;->594 >ss 5< ;98; s"r588r859->
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COMMON CAUSES OF COMMONGI ABDOMINAL PAIN
• A??9;585"5s• G44s"-9 ;5ss• P98r"5"5s• )iverticulitis•
*lcer disease• +sophagitis• ( obstruction• (nammatory .owel )isease /(.)0• F98"5-94 /-74 ;5s-r;r
• 1ascular disease• G698-4-58 8ss• r94 s"-9
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VOMITING
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COMMON CAUSES OF COMMONGI NAUSEA AND VOMITING
• M;58"5-9s• ( obstruction• M-"-r ;5s-r;rs
• F98"5-94 /-74 ;5s-r;r• E9"r58 59 ;5ss
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H>">s5s
• H>">s5s >9s ->5"59 -rrr5""5-9 -<
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M49
• P94r9 9254"$ /r/ /s2$;9 492".
• T# 8-4-rs ;?9; -9 4-9 /"79s"r58 85; Wr9 >49 "r9"9
;r5 4>96 #/99 9"r ;r#;99 s> 4>/9$ /sr 285496?r;r#9$ 28?"9 ?r;r#9$ 4-2s5?r;r#9 ;9 ?rr29 ss.
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PATHOLOGY OF MELENA
• P; >49$ ;4> ?r4996 >445 ss$ ;r# >9;5/r7r9 >r# 4? /#29 #5">. Pr/#9 7r9 595;5s//29 -4# HCL 4>/9$ ??s59$ ;9 7r9 #5"> 595;5; 2r9 ;96 ?5>9 ?-r0r59. K;92;9 ?;?r;r#9 s4r9 8r9 /59 /7# ;r5 ss #4s "2-4-9 s9;9$ 984 ;r5 ;-;9> ;9 9>29 "r"#9 ?; s4r9 8r9 s25"r *! > 9"2>r/# 7r9 9;5 #5">. P459 s;525"?r;r#9 s/962 (%1%% 88 /r ;5>?5 2;9>49. Fss ""? /r7r9 #5"> s?r"5 "r s4> '!)
> s"4# ?r;r#9 /r#9"5. I95 /29 /rr"5 24r96/965 "r;?" ?; )1% #r5 s"4# ?5s-; ?r;r#9 "94.
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1(%)('+ 1ascular/10
(nammatory/(0
%eoplasm/%0
)egenerativeand )e4ciency/)0
(ntoication/(0
Os-?#s esophageal varices
ROs-?#"5"5s
arcinomaoesophagus 9;49
L6 9; -"#r5rr5"9"s
*lcer
A-r"589r6s>
Tr6?9-s->5s5s 8r5
F-r59 /-;6
S"->8# Cr;58
r58s
astritis arcinoma A"r-?#58
s"r5"5s
A48-#-458
s"r5"5s$s?5r59$ 9;-"#r ;rs..$ rs958
R?"r;9r6s>
Gs"r58 48r
D-;9> *lcerP98rs A8"
?98r"5"5s#>-rr#58
B4--; L25>5 A?4s"58 9>5 Wr59 K;085986
H?r59
O"#r ;rs
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1(%)('+
ongenital/0
'utoimmune'llergic /'0
rauma/0
+ndocrine/+0
Os-?#s
H5"4 #r95 S84r-;r> F-r59 /-;6
esophagitis Ns-s"r58"/
7allory-8eisssyndrome
S"->8# Hr;5"r6"4958"s5s
Pr
D-;9> R5-94 545"5s Pr
P98rs
B4--; H>-?#5459; -"#r C-449;5ss 9;
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e9ala +soagus :ambung )uodenum :ower (
N6r5 •A2#4s5•R2s
•Gs"r58 U48r•C Gs"r58
•D-;94 U48r •IBD•D5r"584
M4
M9"#
•A2#4s5•R2s
•C Es-s5s
•+sophagitis•;uptur1arices+soageal•
7allory-weissear•1ascular:esions•%eoplasm
•astric *lcer•astritis•1aricesastric
•)uodenal *lcer•1arices)uodenal
M49$Fr92 B4--;$O884"B4--;
•R?"r Vr58sEs-
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ESOFAGITIS
• Es-?#5"5s ;4# ?r;99 ?;s-99229;96 ?9;r#9 >9;;2
– ( ?9;r5" >94# ;5s
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CLASSIFICATION OFESOPHAGITIS
• K4s502s5 /r;sr29 "5-4-5 :
– s-?5"5s ??"52 r2s
– esopagitis korosi
– s-?5"5s 59
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ESOPAGITIS KOROSIF
• Pr;99 ;5 s-95>/429 2rs29?; s4r9 69 ;544596
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ETIOLOGI J PATOFISIOLOGI
• ,"" 25>5 /r? s> 2" J /s 2" >96//29 2>"59 s4 ?; ?r>29 69;544596
• Krs29 2r9 /s 2" s4 s4 >"5 ;9>985r
• Krs29 2r9 s> 2" 2>"59 s4 69>9>?4.
• P; 2rs29 69 ;5s//29 -4# s> 2"$>2 2rs29 29 ;54>5 4/5# /r" ?;4>/9 ;52r929 ;96 s> 4>/9 69"r" >>?r/r" 2rs29 s4s4 ?; >2-s$""?5 ?; /s 2" 69 "r;5 ;4# s/45296$2rs29 4/5# /r" ?; s-?#s.
• ," -r952 s?r"5 45s-4 J 2r/-4 >95>/429;> ;5 >2-s " s/>2-s
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KARSINOMA ESOFAGUS
• S9" 2->?42s ;9 >45299
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MACAMMACAM KARSINOMAESOFAGUS
• Krs59-> ?5"4 /r4?5s ?9
• A;9-2rs59->
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TANDA OB+EKTIF
• Rr5"s5 >9-9-4 ?; 2;9 4/5# 49".• Sr ?r /5s "r;5 ?/54 ?5" sr >94>5
?r45s5s.• B"2 2r-952 "5>/44 /54 "r;5 0s"4 s--r s>?" >9"# ;r# ;?" "r;5.• S59;r-> H-r9r• Pr45s5s ;5• K->?rs5 ?42ss /r2545s• S59;r-> 9 8 s?r5-r• E
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GE+ALA
• S";5> ;595 /4> ; 24#9$ /5s9624#9 "> /5s96 ;5s299 "rs92" ?; "9-r-29;9 ;r# r"r-s"r94 ;524#49 #>?5r&% ?s59. O;59-r?2924#9 s/2"5< ?9;r5".
• P9;r5" 29 s45" >949 >299?;" ;9 85r. L/5# 49" 29>95>/429 rr5"s5 ?; s">29 " >59>.
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VARISES ESOFAGUS
• Tr;5 s/5 25/" #5?r"9s5?-r"4 "r/9"2 2-4"r4$ ;59"r96 9 ;5 s-9;5 /sr$ s#59 "5>/4r5ss s-
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M44-r6W5ss s69;r->
• S/4> "5>/4 #>">s5s ;5;#45>9"#>9"# #/" 69 ?; 2#5r96/r "5>/4 ?r;r#9$ >5s496 ?;?>59> 42-#-4 " ?; #>54 >;.
• B5s96 ;5s//29 -4# 2r9 "r44sr59 >9"#>9"# #/" ;9 "rs>9rs.
•
B54 ?9;r5" >94>5 ;5s92599 ;5s//29 -4# 2rs59->s-
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GASTRIC VARICES
• Gs"r58 r58s r >-r#>-;69>58
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GASTRITIS
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C#r-958 Gs"r5"5s
A"r-?#58 Gs"r5"5s Er-s5 Gs"r5"5s
Vr545
Gs"r5"5s
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GASTRITIS
• Gs"r5"5s 5s 9 59>>"5-9$5rr5""5-9$ -r r-s5-9 -< "# 45959 -<"# s"->8# s"r58 >8-s. I" 89
-88r s;;946 8" -r r;4468#r-958.
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RISK FACTOR OF GASTRITIS
• H. ?64-r5 59
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ETIOLOGY OF GASTRITIS
• B8"r54 59>9 s"r5"5s
• O"#r ;5sss 9; 8-9;5"5-9s
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SYMPTOMS OF GASTRITIS
• Ns -r r8rr9" ?s" s"->8#
• A/;->594 /4-"59
• A/;->594 ?59
•
V->5"59• I9;5s"5-9
• Br959 -r 9759 8#/"79 >4s -r " 95#"
• V->5"59 /4--; -r 8- r-9;452>"r54
• B482$ "rr6 s"--4s
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ULKUS PEPTIK
• S" ;r# 2s2-r5s5 >2-s4>/9 " ss 69 "r">;5s//29 2r ?98r99 "#
4>/9 " s2rs5 ss #4s/59 "s
EPIDEMIOLOGI ULKUS PEPTIK
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EPIDEMIOLOGI ULKUS PEPTIKDI AMERIKA SERIKAT
• ' " ?s59 /r J 2>/#"r29 42s ??"52 ?r "#9
• 1 ?r5 J 1% 795"
• 1(.%%% 2>"59 ?r "#9 "r;525/" 42s ??"52 69"r2->?452s5
ETIOLOGI J FAKTOR RISIKO
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ETIOLOGI J FAKTOR RISIKOULKUS PEPTIK
• K"5;2s5>/99 9"r 28?"9 s2rs5"# 4>/9 J ;r" 69 ;5/r529 s7r>2-s s"r-;-;94 J 9"r45ss5 s>4>/9 -4# "# ;-;9>
•
K9;99 s> ;9 ??"52 Q• Ir5"s5• S?45 ;r# 69 /r2• S2rs5 >2s 69 /r4• I9
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PATOFISIOLOGI ULKUSPEPTIK
• H ?64-r5 ?9"rs5 2>>?9 0s52 "4?s29 95>95> ?98r99 /2"r5469 >985r29 s7r s7r >2-s 4>/9 "# s> 2" ?98r99
?9"rs5 r599 ?5"45> J 8r9;59;59 GI 42s ??"52>
• Mr-2-2 ?Q r9s99 sr< ?;249r ?962rs- ;5 4>/9
• A42-#-4 >rs2 s7r >2-s
• As?5r59 J OAINS >rs2 s7r >2-s
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GE+ALA ULKUS PEPTIK
• S25" ?r"
• K->?452s5 1% ?s59 ;99 OAINS69 59;2s5 ?9625" >2-s :
P9;r#9$ ?r
• K"5;296>99 /r#/99 ;99
2-9;5s5 >299$ 9s$ J BB• D5s??s5
CLASSIFICATION OF PEPTIC
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CLASSIFICATION OF PEPTICULCER
+&=#'*& '&+; )*)+%*7 >+>*%*7
LETAK D5 " 4 # A 4 " D5 ;5 D5 " 4 ; 5
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LETAK D5s"4 s-?#s A94s$ 9"r>$?r?54-rs
D59;599"r5-r ;9?-s"r5-r ;r5/4/s ;-;95
Prs ;s89;9
;-;95 ?r-2s5>4 ;r5??54 "r55
D5s"4 ;r59s"->-s ;5;59;59 9"r5-r
9>
NYERI B59 /7# s"r9>4 #"5 >9/r5>
s"r95 ;9 59"rs2?4r?99
Pr" 25r5 "s ?5s"r5>
?99 25r5A;96 96r5
"29 ;5?5s"r5>
Pr" 299"s ?r"
25r5 ;9?599 "s
N6r5 "29 ;5?r" 299"s ;2">/5452s
D5 ?r"$ /5925r5 >/5452s 2 ?599 25r5
N6r5 "29 ;5?r"$ s/4#25r5 >/5452s
RITME
NYERI
S" >29 >59>M>/9229 /;9
>29 96r5
96>9
T9# >4>
M29
96>9 96r5
SIFATNYERI
?9s ;5 ;; ;9 4#"5>4>9"#
Ms> ;5 >4" P;5# ;9?9s ;5 ?r"299 "s
P;5# ;9 ?9s;5 ?r" /5925r5 >/5452sM4M9"#
Ms> ;5 >4"
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CA GASTRIC
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F2"-r rs52-
• F2"-r rs52- 292r s"r 9"r 459#452-/2"r ?54-r5$ ;5" "595 95"r" 95"r-s>59s/5 ?97"$ >299 6 ;5s5929 ;9;5s?$ ?r-2-2$"r-0 4>/9.
•
D5 s>?59 5" ; ?9 – U>r$ 2/9629 292r 4>/9 ?; >r (%
)% "#9 ;9 r9 ;5 /7# '% "#9. – A42-#-4 – O?rs5 4>/9 s/4>96 – P-45? 4>/9 – S59;r-> 292r 5454
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KLASIFIKASI TUMOR +INAK
• T>-r 592 ?5"4
• T>-r 592 9-9 ?5"4
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TUMOR +INAK EPITEL
• A;9->
• A;9-> #5?r?4s"52 : ?-45?-5;s5r2>s2r5?$ ;5 #"r-"r-?52 : ">-r?92rs /r9$ /r959->
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TUMOR +INAK NON EPITEL
• T>-r 9r-952
• L5->5->
• F5/r->
• L5?->
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KLASIFIKASI TUMOR GANAS• Er46 s"r58 898r.
– T5? 1 ?r-"r;; "6?. T>-r 9s 6 >959s5 #96"r/"s ?; >2-s ;9 s/>2-s 6 /r/9"2?-45?-5;. B9"296 5r4r$ ?r>29 "5;2 r"$?r;r#9 ;99 "9? 4srs5.
– T5? s?r0854 "6? ;?" ;5/5 3 s/"5? :
. E4"; "6? : ">?2 s;525" 4s5 >2-s 4>/9$ #>?5rs?r"5 "5? 1$ ">?2 s?r"5 4s5 sr" ;9 4/5# >4s ;9>4/r.
/. F4" "6? : "5;2 "r45#" 4s5 ;?rs5 ?; >2-s ;9 #96"r45#" ?r/#9 7r9 >2-s
8. 8. D?rss; "6? : ;5;?"29 ?r>29 6 5r4r ;9 ?595r
6 "5;2 r" #5?r>5s ?r;r#9. – T5? 3 8"; "6? : >96r?5 B-r>99 II ">-r
9s 49" ;9 ;5sr"5 2->/59s5.
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KLASIFIKASI TUMOR GANAS
• A;98; s"r58 898r 2rs59-> 292r 49".M9r" 24s502s5 B-r>99 ;?" ;5/5 "s : – B-r>99 I. B9"296 /r? ?-45?-5; 2rs59-> 6 sr59
;5s/" 99 II. Mr?29 9-9 5904"r"59 8r859->"-s 48r
;99 "?5 42s sr" >2-s >9-9-4 ;9 ;5sr"5 9-;4r.Dsr 42s "r45#" 92r-s5s ;99 7r9 28-24"9$ 2/9$;9 >r# 2#5">9. M2-s s25"r 42s ">?2 s9"#5?r>5s
– B-r>99 III. Br? 5904"r"59 8r859->"-s 48r. U42s96>>?965 ;59;59 ;9 "r45#" ;96 5904"rs5 ?r-rs5< ;9
;599 IV. Br? /9"2 ;5
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PATOLOGI
• K/9629 292r s"r ;4# ;9-2rs59-> &%&&.
• Krs59-> s"r /rs4 ;r5 ?r/#9 ?5"4 ?;>>/r9 >2-s s"r$ 6 /r2>/9 ?; /59/7# s"r$ s;929 ?; "r-0 s"r
;5;?"29 /59 "s s"r ;9 s8r >4"5s9"r.• Krs59-> s"r "r45#" //r? /9"2:
– S?r>?"96 /rs4 ;r5 ?r-?5 6 /r/9"2/# 2 4>9 s/5 >ss
– S?r>?"96 /r/9"2 ">-r 6 /r4srs5 – Mss 6 ">/# >44 ;59;59 >959s5 4?5s9 -"-" – P96/r996 >44 ;59;59 6 ;58>r5 ?96/r9
?; ?r>29 – Br/9"2 4595"5s?4s"52 – S?r"596 2rs59-> /r/9"2 s?r"5 6 ;5 "s
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GE+ALA KLINIS
• K4#9 "> ">-r 9s s"r : – Br" /;9 >9r9 – N6r5 ?5s"r5> – M9"# – K4#9 ?98r99 – A9-r2s5 – K4#9 >> – D5s#9 – S9;7 – H>">s5s – Rr5"s5 – L2s 2969
• G4 6 ;5"5>/429 -4# >"s"s5s ;?" /r? ?r">>/sr As85"s$ 52"rs -/s"r2"5
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INFLAMMATORY BOWEL
DISEASE
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DEFINISI J KLASIFIKASI
• P9625" 59>s5 69 >45/"29s4r9 8r9$ ;99 ?96//?s"596 /4> ;52"#5 4s IPDFKUI$ %%*
• S8r r5s /sr ;5/5 3 95s: – K-45"5s 4sr"5
– P9625" Cr-#9 – B54 s45" ;5/;29$ >2 ;5>s229
;4> 2"-r5 I9;"r>59" C-45"5s.
8/15/2019 GROUP 03 CASE 1A.ppt
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KOLITIS ULSERATIVA
• K-45"5s U4sr"5 >r?29 s"?9625" >9#9$ ;5>9 ss /sr>94>5 ?r;99 ;9 42$ 69
>96//29 ;5r /r;r#$ 2r>?r" ;9 ;>>.
• P9625" 595 /5s96 ;5>45 ;5 r2">
" 2-4-9 s5>-5; 9 /7# ;r5ss /sr ;9 2#5r96 >96/r 2s/59 " s4r# ss /sr.
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KOLITIS ULSERATIVA
• S" sr99 /5s >9;;2 ;9 /r"$>96//29 ;5r #/"$ ;>> "595$ s25" ?r";9 ?r5"-95"5s r;9 s4?" ?r". S4>sr99$ ?9;r5" ">?2 s9" s25".
• Y9 4/5# sr59 "r;5 ;4# sr9996 ;5>45
/r"#?$ ;5>9 ?9;r5" >>54525 259599 9"2/9 5r /sr 69 s9"$ 2r> r599 ?; ?r"/7# ;9 "59 69 /r;r# ;9 /r49;5r.
• +52 ?9625" 595 "r/"s ?; r2"> ;9 2-4-9s5>-5;$ "59 >9259 9-r>4 " 2rs ;9 2r59.
T"?5 s4> " ;59"r 72" /9 5r /sr$
;r5 r2"> 24r 49;5r 69 >99;9 /962s4 ;r# >r# ;9 s4 ;r# ?"5#.G4 >> /r? ;>>$ /5s r599 " >4#"5;2 >984.
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KOLITIS ULSERATIVA
• +52 ?9625" >96/r 2 ss /sr$ "59 4/5#492 ;9 ?9;r5" /9 5r /sr s/9621%% 245#r5.
• P9;r5" sr59 >94>5 2r> ?r" 69/r"$ 29 ?; r2"> 69 "rs 96r5$;5sr"5 259599 9"2 /9 5r /sr 69s9". P; >4> #r5?9 4 595 "5;2/r2r9.
• T59 ">?2 98r ;9 >99;9 99#$;r# ;9 49;5r. Y9 ?459 sr59 ;5">29
;4# "59 69 #>?5r s4r#96 /r5s5 ;r#;9 99#.P9;r5" /5s ;>>$ 92996>9r9 ;9 /r" /;996 /r2r9
8/15/2019 GROUP 03 CASE 1A.ppt
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CA KOLON
• K92r ss /sr r9>96//29 ;>> "24r96 99# ;r5 r2">$ 9>9
#rs ;5025r29 292r s/52>92599 ?96// ;5r/r;r#.
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8/15/2019 GROUP 03 CASE 1A.ppt
75/99
ETIOLOGY
• P96// ?9625" Cr-#9 "5;2;52"#5.P945"59 >>s"29 ?r#"59
?; "5 2>92599?96//96$ 65": K4599
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SIGN
• N29 /r2r9• P9r99 /r" /;9.• P; ?>r52s9 0s52 ;5">29 /9-49 " rs ?9#
?; ?r" /59 /7#$ 4/5# sr59 ;5 s5s5 299.• S25"r s?r"5 ?9;r5" ?9625" Cr-#9 >>54525
>s4# ;5 s25"r 9s$ "r"> 0s"4 ;9 48" 0ssr?; 4?5s9 s4?" 49;5r 9s.• P9645" Cr-#9 ;5#/929 ;99 24599 "r"9" ?;
/59 "/# 45996$ s?r"5 /" >?;$ 24599?96r?9 " 55 ;9 ?9>?29 >54-5; >54-5;-s5s.
• P; 9292$ 44 s4r9 ?98r99 s?r"5s25" ?r" ;9 ;5r sr59 /29 >r?29 4 ">;9 /5s "5;2 >984 s> s245.G4 ">96 >9259 /r? ?r;99 s9;5$;>>$ 9>5 " ?r">/#9 69 4>/".
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8/15/2019 GROUP 03 CASE 1A.ppt
78/99
FISSURA ANUS
• >r?29 s" r/29 " 42/r99# 42s$ /-r-2 ?; 4?5s9 9s.
•
PENYEBABB5s96 ;5s//29 -4# 8;r 2r9/9 5r /sr 69 2rs ;9 /sr.F5ssr >96//29 -"-" >4592rs09"r ;r5 9s >94>5 29 ;9#4 595 29 >9645"29 ?96>/#9.
G
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79/99
GE+ALA
• F5ssr >96//29 96r5 ;9?r;r#9 s4> " srs"4# /9 5r /sr.
Rs 96r5 29 /r49s9 s4>//r? >95" s>?5 //r? >;9 2>;59 >9#549 s>?5
s" /9 5r /sr /r52"96.
%yeriepigastrik
r599S;9
/r"
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epigastrik
E9;-s8-?6 R6GI /59 "s Tr?5 ;99
9"s5;
9"-95s H
Pr/529
G4""?
9;-s8-?6
T5;2;
4s5 49"
Tr?5 ;999"s5;$ 9"-95s
H$ ->?r-4$ "9"5/5-"52 H. ?64-r5
Gs"r58 48r/5-?s6 48r
;s$ s5"-4-5$/5-?s5 H. ?64-r5
D-;94 48r$r-s5-9s$ "
59>s5;-;9>
4>/9
B5-?s5 H.
?64-r5
Tr?5 ;99
9"s5;$ 9"-95sH$ ->?r-4$
" 9"5/5-"52 H.?64-r5
Pr/529 G4""?
T5;2 ;4s5
49"
Pr"5>/929 :R9;-s8-?6$H.?64-r5$ sr>
s"r59$ 9-98->?459" ?"59"
P96>/#9-4# 9;-s8-?6
;-2>9 r6s";6
+52 "5;2s>/# ;4>
1* >59$?r"5>/929
"59;29 /;#
-/"5-94
Gs"r-59"s"594 /4;59
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94 /4;59
C-9s4"sr-9
Tr98#
Pss9s-s"r58
8/15/2019 GROUP 03 CASE 1A.ppt
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59s"->8#
W5"#;r7
"/
U??r GI
9;-8-?6
C-9s5;r : s48"5r"r5-r?#6
5>>;5" srr6
N-9;59-s"58 -r
/4;59
rs52-
;59-s"58
s"->8#
;59-s"58 N-9;59-s"58
Pr-8"-s5>-5;-s8-?6
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DIAGNOSA SEMENTARA
• Br;sr29 9>9s 2ss$ ;5; Mrs. D-/"0r >9;r5" 42s??"52> ;99 24#9 96r5 ;5
?5s"r> 69 "5>/4 ?r5-;52$>4 >9"# .
8/15/2019 GROUP 03 CASE 1A.ppt
84/99
PEMERIKSAAN PENUN+ANG
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85/99
PEMERIKSAAN PENUN+ANG
• A945s 4>/9 >r?29 s"?r-s;r ;5>9 85r9 4>/9 ;5#5s?s8r 49s9 ;r5 4>/9 ;9;-;9> s#59 >4# s> /5s
;52r.Pr-s;r 595 ;54229 #96 5242s96 /r" " /r49 "s/4> ;5422996 ?>/;#9.
•
H5"9 95s ;r# /5s >99"29;96 9>5 25/" ?r;r#9 42s.P>r5s9 ;r# 45996 /5s>9>29 ;96 H458-/8"r ?64-r5.
TREATMENT
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TREATMENT
• A9"s5; >9r95 4$ >>?r8?" ?96>/#9;9 >9r95 >4# 92 22>/#9 ;r5 42s.
• A9"s5; 69 ;?" ;5sr?. – O/" 595 ;99 sr 29 >9"r429 s4r# s>
4>/9. – Y9 ?459 2" ;4# 9"r5> /52r/-9" ;9 24s5>
2r/-9"$ 69 59>.
– O/" 595 ;5sr? -4# 45r9 ;r#$ s#59 ?>259"rs >9rs /5s >96//29 ?r/#9 ;4>2s5>/99 s>/s ;r# ;9 >96//29
"r;596 424-s5s s59;r-> 4245ss. Kr9 5" -/"595 /5s96 "5;2 ;5929 ;4> >4# /sr s4>4/5# ;r5 //r? #r5.
TREATMENT
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TREATMENT
• A9"s5; 69 "5;2 ;?" ;5sr?. – O/" 595 4/5# ;5s25 2r9 ?5996
4/5# s;525"$ "5;2 >96//29 424-s5s.
–
O/" 595 /r52"9 ;99 s> 4>/9>>/9"2 /#9 69 /r"#9 ;5 ;4>4>/9$ >9r95 2"55"s 85r985r9?98r99 ;9 >9r95 4 42s"9? >96//29 424-s5s.
T"?5 9"s5; 595 >>?9r#5 ?96r?9-/" 45996 >5s496 ""r8684459$ ;5-59 ;9" /s5 2 ;4> ;r#.
TREATMENT
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TREATMENT
• A4>95> H;r-2s5;. – Mr?29 9"s5; 69 r4"5< >9 ;9 /962
;5929. T"?5 4>95> ;?" /r52"9;99 925/"29 #54996 929 ;94>s.
– Rs52- "5>/496 ?59 595 4/5# /sr
?; ?9;r5" 69 42-#-452 ;9 ?9;r5"?9625" 594 "r>s2 69 >9495#>-;545s.O/" 595 /5s >96//29 s>/45".
TREATMENT
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TREATMENT
• M9s5> H5;r-2s5;. – Mr?29 9"s5; 69 4/5# >?9r#5 2/5s9 /9 5r/sr ""?5 /54 4/5# ;r5 ' 245 /5s>96//29 ;5r.
– S>4 2854 >9s5> ;5sr? 2 ;4>;r#$ s#59 -/" 595 #rs ;5/r529 ;4>;-s5s 2854 2?; ?9;r5" 69 >94>5
2rs29 594.B962 9"s5; 69 >99;9 >9s5>;9 4>95> #5;r-2s5;.
TREATMENT
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TREATMENT
• A9"-95s H. – C-9"-#96 ;4# 85>"5;59$ r95"5;59$ -"5;59 ;9
95"5;59.O/" 595 >>?r8?" ?96>/#9 42s ;99>9r95 >4# s> ;9 95> ?98r99 ;5
;4> 4>/9 ;9 ;-;9>.
– D5>59> 1 245#r5 ;9 //r? ;59"r96 /5s;5?r-4# "9? rs? ;-2"r.
– C5>"5;59 /5s >>?9r#5 ?>/99 -/""r"9" ;r5 "/# >5s496 "-0459 9"2 s>$7r
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TREATMENT
• O>?r-4 ;9 I9s-?r-4.Mr?29 -/" 69 s9" 2" >9#>/" ?>/9"2995> 69 ;5?r429 4>/9 9"2 >>/" s>.O/" 595 ;?" s8r "-"4 >9#>/" ?4?s9 s> ;9. Tr"> 4>/9 >5s496s59;r-> ,-4459rE445s-9.
• M5s-?r-s"-4.D5929 9"2 >98# 42s s"r52> 69 ;5s//29-4# -/"-/" 9"5 ?r;99 9-9s"r-5;.
O/" 595 ;5/r529 2?; ?9;r5" r"r5"5s 69>92-9s>s5 -/" 9"5 ?r;99 9-9s"r-5; ;-s5s "595. T"?5 -/" 595 "5;2 ;5929 ?; s> ?9;r5" r"r5"5s"rs/" 2r9 >96//29 ;5r ?; 3% ?9;r5".
TREATMENT
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TREATMENT
• A9"5/5-"52.D5929 /54 ?96// "> "r;596 42s;4# H458-/8"r ?64-r5.P9-/"9 "r;5r5 ;r5 s" >8> " 4/5#9"5/5-"52 ;9 -/" 9"2 >9r95 "
>9"r454s5r s> 4>/9. Y9 ?459 /962 ;5929 ;4# 2->/59s5/5s>" s/s45s54" s95s s8r4?r-4 ;99"5/5-"52.
P9-/"9 595 /5s >9r95 4 42s$/#29 52 42s "5;2 >>/r529 rs?-9"r#;? ?9-/"9 s/4>96 " 52 42ssr59 >94>5 22>/#9.
TREATMENT
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TREATMENT
• PEMBEDAHAN
59;52s5 ?>/;#9:
– >9"s5 2->?452s5 ;r5 42s ??"52>>5s496 ?r/"9 69 "5;2>>/r529 rs?-9 "r#;? ?>/r59 -/"" >94>5 22>/#9
– 245 " 4/5# ?r;r#9 2r9 42s
– 42s s"r52> 69 ;58r55 29 >9;59s
– 42s ??"52> 69 /r" ;9 sr59 2>/#9
KESIMPULAN
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KESIMPULAN
• Mrs. D-/"0r >94>5 ;5s??s5$#>">s5s ;9 >49 69>9r# ?; ?9;r#9 s4r9
8r9 "s 65" 42s ??"52>.
SARAN
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SARAN
• I;9"502s5 ;9 ?9#59;r9 >299 6>96//29 s2rs5 HCL /r4/5#9
• P9;5;529 >995 >9#59;r5 42-#-4;9 2/2 ;?">>?r4>/" ?96>/#9• P9"42s99 s"rs$ "2952 r42ss5 "
s;"5< 9"2 >9"s5 ?9r# ?s52-4-5s• A9"s5; 9"2 >9"r429 s>• P>/r59 A/ 6 s?s502 9"2 #.?64-r5• A9"-95s rs?"-r #5s">59 6 >9r95
s2rs5 s> -4# s4 ?r5"4
REFERENCES
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REFERENCES
• Iss4/8#r$ Kr" +. Hrr5s-9 Pr59s5?Pr59s5? I4>P9625" D4>. EGC. +2r": %%%.
• Ks?r DL$ Br974; E$ F85 AS$ Hsr SL$L-9- DL$ +>s-9 +L$ ;5"-rs. Hrr5s-9@s Pr5985?4sO< I9"r94 M;5859. 1*"# ;. N7 Y-r2: M8Gr7
H544$ %%)• F85$ Ks?r$ Br974;$ " 4 %%! Hrr5s-9@s
Pr5985?4s -< I9"r94 M;5859 N7 Y-r2 : M8Gr7 H544
• M992s>- E$ S-"5?"- D. B2 Ar I4>
Ks#"9 T459 H5;9 T9-r-2 K?4 ;9L#r. FKUI. +2r" : %%).• H;5$ ?r-
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REFERENCES
• Mrs8#44 S R9$ M A9;r7 Gr9"5. N""r@sI9"r94 M;5859. E;5s5 . C#59: S9;rs$ %%&.
• Ar"#r C G6"-9$ +-#9 E H44. B2 Ar F5s5-4-5K;-2"r9. E;5s5 11. +2r": EGC$ %%).
• Fr;r58 H Mr"595$ E;759 F Br"#-4->7. Ess9"54 -<
A9"->6 J P#6s5-4-6. E;5s5 (. A>r52 Sr52":Prs-9$ %1%.• S45>9 H. A45$ D4;56-9-$ A2/r H. Nr4$ R95 A.
A5. 1&&). Gs"r-9"r-4-5 H?"-4-5. +2r":S9 S"-
•
S;-6-$ Ar W. B2 Ar I4> P9625" D4>. FKUI. +2r" : %%*.• D6$ P"r582. A" G498 M;5859. EMS. %%3.• R-//59s$ K>r. P"-4-5 ;5s5 '. EGC. +2r": 1&&(.
D
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D;58s"-r.8->. P9;r#9S4r9 Cr9. R"r5; : s" *$%%&.
• #""?:777.>;58599".8->.s-?#5"5s.R"r5;: As" * $ %%&.
• #""?:777.>;5859.8->. s-?#5"5s.R"r5; : As" *$ %%&.
•
777.7/>;.8->• 777.7r-9;59-s5s.8->
• 777.>;58s"-r.8->
THANK YOU
http://www.webmd.com/http://www.wrongdiagnosis.com/http://www.medicastore.com/http://www.medicastore.com/http://www.wrongdiagnosis.com/http://www.webmd.com/
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THANK YOU