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BAGIAN ILMU PENYAKIT DALAM LAPORAN KASUS
FAKULTAS KEDOKTERAN Januari 2015
UNIVERSITAS HASANUDDIN
SIROSIS HEPATIS
OLEH :
Sri a!"uni R#
$111 11 %&'
PEMBIMBING :
(r# L)*nar( Ka+*,i
PEMBIMBING BACA :
(r# A-!"ar A,.aar
DIBAAKAN DALAM RANGKA KEPANITERAAN KLINIK
BAGIAN ILMU PENYAKIT DALAM FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN
MAKASSAR
2015
1
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LEMBAR PENGESAHAN
Yan/ .)ran(a an/an (i .aa! ini +)n"aa-an .a!a 3
Na+a 3 Sri a!"uni R#
NIM 3 $111 11 %&'
Uni4)ria 3 Haanu((in
Ju(u, 3 Sir*i H)6ai
),a! +)n"),)ai-an ,a6*ran -au ()n/an 7u(u, )r).u (a,a+ ran/-a
-)6ani)raan -,ini- 6a(a .a/ian I,+u P)n"a-i Da,a+ Fa-u,a
K)(*-)ran Uni4)ria Haanu((in#
Ma-aar Januari 2015
P)+.i+.in/ $*a
dr. Leonard Kamoli Sri Wah!ni R.
P)+.i+.in/ Ba8a
dr. A"har Al#aar
2
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BAGIAN ILMU PENYAKIT DALAMFAKULTAS KEDOKTERANUNIVERSITAS HASANUDDIN
CATATAN RIWA$AT PEN$AKIT
Na+a P)n()ria 3 Tn# SJ)ni K),a+in 3 La-i9,a-iT/, ,a!ir 3 &9591&'5A,a+a 3 Bau9.auN*# R)-a+ M)(i 3 :&2;&5Tan//a, P)+)ri-aan 3 119129201;
D*-)r +u(a 3 Sri a!"uni R#
I. SUB%EKTI&
a.Anamnesis :Au*ana+n)i
b.Keluhan Utama : P)ru +)+.)ar
c.Anamnesis Terpimpin :
- P)ru +)+.)ar (ia,a+i )7a- 2 +in//u ).),u+ +au- ru+a! a-i
(iraa-an +)+.)ar 6)r,a!an9,a!an i(a- a(a n")ri 6)ru 8),ana
)raa +)n")+6i (an 6)ru )raa 6)nu!# Mua, (an +una! i(a- a(a
na+un ria"a +una! (ara! a(a 2 +in//u "an/ ,a,u ()n/an 4*,u+)
)-iar 500 88# Naaa+
+)
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Ria"a +)r*-*- a(a )7a- 5 a!un "an/ ,a,u )a6i .)r!)ni )7a-
+au- ru+a! a-i aa +au (i*6)rai !)rnia = +in//u "an/ ,a,u
Riwayat penyakit sebelumnya :
- Ria"a +)n()ria 6)n"a-i -unin/ >@? )7a- 12 a!un "an/ ,a,u
- Ria"a !i6)r)ni >9?
- Ria"a DM >9?
Riwayat pribadi dan keluarga :
- Ria"a +)r*-*- >@? )7a- 5 a!un "an/ ,a,u )a6i .)r!)ni )7a-
+au- ru+a! a-i aa +au (i*6)rai !)rnia = +in//u "an/ ,a,u
-Ria"a +inu+ a,-*!*, i(a- a(a
II. OB%EKTI&
' S(a(!) Pa)ien :
- Sa-i )(an//ii 8u-u68*+6*+)ni
- BB 3 55 -/
- TB 3 1:5 8+
- IMT 3 551,652 C 2022 -/+2>N*r+a,?
' Tanda *i(al :
- T)-anan (ara! 3120'0 ++H/ r)/u,)r -ua an/-a#
- Na(i 3 %% +)ni
- P)rna6aan 3 22+)ni
- Su!u 3 =:5*$
' Pemeri")aan &i)i" :
Ke+ala
- E-6r)i 3 Biaa- Si+)ri +u-a 3 Si+)ri -iri (an -anan- D)
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Ma(a
- E-*6a,+uEn*6a,+u 3 >9?- G)ra-an 3 Da,a+ .aa n*r+a,- T)-anan .*,a +aa 3 Da,a+ .aa n*r+a,
-K),*6a- +aa 3 E()+a 6a,6).ra, >9?
- K*n7un/i4a 3 An)+i >@@?- S-,)ra 3 I-)ru >@@?- K*rn)a 3 J)rni!- Pu6i, 3 Bu,a i*-*r
25++25++
Telin,a
- T*6!i 3 >9?- P)n()n/aran 3 Da,a+ .aa n*r+a,
-N")ri )-an (i 6r*)u +a*i()u 3 >9?
Hid!n,
- P)r(ara!an 3 >9?- S)-r) 3 >9?
M!l!(
- Bi.ir 3 Pu8a >9? K)rin/ >9?- Gi/i /),i/i 3 $ari) >9?
-Gui 3 P)r(ara!an /ui >9?
- T*ni, 3 T1 T1 !i6)r)+i >9?- Farin/ 3 Hi6)r)+i >9?- Li(a! 3 K**r >9? r)+*r >9? !i6)r)+i>9?
Leher
- K),)n7ar /)a! .)nin/ 3 Ti(a- a(a 6)+.)aran- K),)n7ar /*n(*- 3 Ti(a- a(a 6)+.)aran- DVS 3 R 92 8+H2O- P)+.u,u! (ara! 3 Da,a+ .aa n*r+a,
-Ka-u -u(u- 3 Ti(a- a(a >9?
- Tu+*r 3 Ti(a- a(a >9?
Thora")
In6)-i
- B)nu- 3 N*r+*8!) i+)ri -iri (an
-anan- P)+.u,u! (ara! 3 S6i()r n)4i >9?- Bua! (a(a 3 Gin)-*+aia >@?
-S),a i/a 3 Da,a+ .aa n*r+a,
5
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- Lain9,ain 3 Ti(a- a(a >9?P!n,,!n,
Pa,6ai 3 N")ri )-an >9? Maa u+*r >9?
N")ri -)*- 3 Ti(a- a(a >9?
Au-u,ai 3 Bun"i 6)rna6aan3 V)i-u,)r
R*n8!i 99 !))in/ 99
G)ra-an 3 Da,a+ .aa n*r+a,
Par!
Pa,6ai
- Fr)+iu ra.a 3 Si+)ri -iri (an -anan#-
N")ri )-an 3 Ti(a- a(a P)r-ui
- Paru -iri 3 S*n*r - Paru -anan 3 S*n*r - Baa 6aru9!)6ar 3 I$S VI ()-ra an)ri*r- Baa 6aru .),a-an/ -anan3 )in//i 8*,u+na
4)r).ra !*ra-a, I ()-ra- Baa 6aru .),a-an/ -iri3 )in//i 8*,u+na 4)r).ra
!*ra-a, inira
Au-u,ai
- Bun"i 6)rna6aan 3 V)i-u,)r
- Bun"i a+.a!an 3 R*n8!i 99 !))in/ 99
%an(!n,
In6)-i 3 I8u 8*r(i i(a- a+6a-
Pa,6ai 3 I8u 8*r(i i(a- )ra.a
P)r-ui 3 P)-a- .aa 7anun/ -)an n*r+a, >.aa
7anun/ -anan (i ,in)a 6ara)rna,i ()ra .aa 7anun/
-iri (i ,in)a +i(8,a4i8u,ari inira I$S V .aa 7anun/
aa I$S II?
6
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Au-u,ai 3 Bun"i 7anun/ III +urni r)/u,ar .un"i
a+.a!an >9?
A#domen
In6)-i 3 $)+.un/ i-u /)ra- na6a (in(in/ a.(*+)n
na+6a- (i)n()( -*,a)ra,iai 4)na >@?
Au-u,ai 3 P)ria,i- >@? -)an n*r+a,
Pa,6ai 3 N")ri )-an >9? +aa u+*r >9?
H)6ar i(a- )ra.a Li)n )ra.a 8!u@?
Ala( Kelamin
Ar*6!i )i >@?
An!) dan Re"(!m
H)+*r*i( >@? 6!in8)r ani +)n8)-i- +u-*a ,i8in
6)+.)aran 6r*a >9? +aa u+*r >9? a+6u,a .)rii 9? ,)n(ir >9?#
E")(remi(a)
Su6)ri*r 3 A-ra, !an/a )ri)+a 6a,+ari >@?
E()+a 3 E()+a >@? 6a(a 6)(i (an 6r)i.ia, ()ra )
inira
La#ora(ori!m
%ENIS
PEMERIKAANHASIL NILAI RU%UKAN
-ARAH
RUTIN
B$ 2% 10=uL ; 9 10 10=uL
RB$ 2;; 10:uL ;: 10:uL
HGB % /(L 12 9 1: /(L
H$T 2=: =' ;%
M$V &:
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M$H$ ==' /(, =2 9 =: /(,
PLT 10010=uL 150 9 ;00 10=uL
NEUT ;=% 52#0 9 '50
LYMP
H =05 200 ;00
MONO 1&= 200 %00
EOS ;' 100 =00
BASO 1' 000 010
%ENIS PEMERIKSAAN HASILNILAI
RU%UKAN
&AAL
HEMOSTATIS
Ur)u+ 1: +/(L 10950 +/(L
Kr)ainin 0: +/(L 11 +/(L
SGOT :1 UL =5 UL
SGPT ;0 UL ;5 UL
H.A/ R)a8i4) N*n r)a8i4)
Ani H$V N*n r)a8i4) N*n r)a8i4)
Pr*)in T*a, 5% /(, :: 9 %' /r(L
A,.u+in 1% /r(, =5 9 50 /r(L
Bi,iru.in *a, 1'5 +/ 11 +/
Bi,iru.in (ir)- 0%; +/ 02 +/
PT 1:% 8*nr*, &: 10 1;
INR 1='APTT 50= 8*nr*, 2' 220 =00
ELEKTROLIT
-ARAH
Nariu+ 1=5 ++*,L1=:91;5
++*,L
Ka,iu+ 2& ++*,L=#595#1
++*,L
K,*ri(a 10'&'9111
++*,L
%ENIS PEMERIKAAN HASIL NILAI RU%UKAN
URIN
RUTIN
arna Kunin/ Kunin/ +u(a
6H :5 ;5 %0
Pr*)in N)/ai< N)/ai<
G,u8*) N)/ai< N)/ai<
Bi,iru.in N)/ai< N)/ai<
Ur*.i,in*/)
n
N*r+a, N)/ai
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Niri N)/ai< N)/ai<
Dara! N)/ai< N)/ai<
L)-*i N)/ai< N)/ai<
Vi $ N)/ai< N)/ai<
S)(i+)n
,)-*i
2 5
S)(i+)n
)rir*i
1 5
S)(i+)n
*ra-
9 9
S)(i+)n
Kria,
9 9
S)(i+)n)6i), ),
9 9
Ha)il USG A#domen :
o Sir*i !)6ai
o S6,)n*+)/a,"
o A8i)
Ha)il Endo)"o+i:
o Vari) )*
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- In
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+)@? )7a-
5 a!un "an/ ,a,u )a6i .)r!)ni )7a-
+au- ru+a! a-i aa +au (i*6)rai
!)rnia = +in//u "an/ ,a,u
O 3 SSG$$M
TD 3 110'0 ++H/
N 3 %; +)ni P 3 20 +)ni
S 3 =' $
An >@? I- >@?
DVS R92 8+H2O
BP 3 V)i-u,)r BT 3 R! 99 ! 99
BJ 3 III +urni r)/u,ar BT >9?
A.( 3 P)ria,i- >@? -)an n*r+a,
H)6ar i(a- )ra.a ,i)n )ra.a
8!u@?
E- 3 E()+a >@@? 6a(a 6)(i (an
6r)i.ia,
A 3
Sir*i H)6ai D)8*+6)naa )#8#
H)6aii Viru B -r*ni-
P* H)+a)+)i M),)na )#8#
Su6)8 Vari8)a, B,))(in/
A8i) /ra() III )#8# Sir*i
H)6ai D)8*+6)naa
Hi6*a,.u+in)+ia
Pani*6)nia -aua
Hi6)r6,)ni+)
7a+*ra,
Tran
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n")ri 6)ru >9? na9? +una! >9?# Ria"a +una! (ara! 2
+in//u "an/ ,a,u ()n/an 4*,u+) )-iar
500 88# A(a n")ri 6a(a anu aa BAB
ria"a BAB )n8)r arna !ia+ 2 +in//u
"an/ ,a,u ),a+a 2 !ari# Ria"a a-i
-unin/ >@? 12 a!un "an/ ,a,u# Ria"a
(ia.)) (an !i6)r)ni i(a- a(a#
Ria"a +inu+ a,-*!*, >9?# Ria"a
+)r*-*- >@? )7a- 5 a!un "an/ ,a,u )a6i
.)r!)ni )7a- +au- ru+a! a-i aa
+au (i*6)rai !)rnia = +in//u "an/ ,a,u
O 3 SSG$$M
TD 3 120&0 ++H/
N 3 %; +)ni
P 3 1% +)ni
S 3 =:' $
An >@? I- >@?
DVS R92 8+H2O
BP 3 V)i-u,)r BT 3 R! 99 ! 99
BJ 3 III +urni r)/u,ar BT >9?
A.( 3 P)ria,i- >@? -)an n*r+a,
H)6ar i(a- )ra.a ,i)n )ra.a
8!u@? E- 3 E()+a >@@? 6a(a 6)(i (an
6r)i.ia,
A 3
Sir*i H)6ai D)8*+6)naa )#8#
H)6aii Viru B -r*ni-
P* H)+a)+)i M),)na )#8#
Su6)8 Vari8)a, B,))(in/
A8i) /ra() III )#8# Sir*i
))+)ni
Fur*)+i( ;0 +/2;
7a+*ra,
S6ir*n*,a8*n) 100+/2; 7a+*ra,
Pr*6an*,*, 10 +/%
7a+*ra,
BRM 1 -a6u,% 7a+*ra,
AHF$ 1 a8!)% 7a+*ra,
Tran
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H)6ai D)8*+6)naa
Hi6*a,.u+in)+ia
Pani*6)nia -aua
Hi6)r6,)ni+)1;12201
;
P)raaan !ari9=
S 3 P)ru +)+.)ar 6)ru )raa 6)nu!
n")ri 6)ru >9? na9? +una! >9?# Ria"a +una! (ara! 2
+in//u "an/ ,a,au ()n/an 4*,u+) )-iar
500 88# BAB -uran/ ,an8ar )+in//u 2
-a,i ()n/an -*ni)ni 6a(a a(a n")ri
6a(a anu aa BAB ria"a BAB )n8)r
arna !ia+ 2 +in//u "an/ ,a,u ),a+a 2
!ari# Ria"a a-i -unin/ >@? 12 a!un
"an/ ,a,u# Pai)n 7u/a .iaan"a
+)n/-*nu+i *.a ana,/)i- >aa+
+)@? )7a- 5
a!un "an/ ,a,u )a6i .)r!)ni )7a-
+au- ru+a! a-i aa +au (i*6)rai
!)rnia = +in//u "an/ ,a,u
O 3 SSG$$M
TD 3 110:0 ++H/
N 3 %% +)ni
P 3 20 +)ni
S 3 =:% $
An >@? I- >@?
DVS R92 8+H2O
BP 3 V)i-u,)r BT 3 R! 99 ! 99
BJ 3 III +urni r)/u,ar BT >9?
P 3
Di) H)6ar II
In
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A.( 3 P)ria,i- >@? -)an n*r+a,
H)6ar i(a- )ra.a ,i)n )ra.a
8!u@?
E- 3 E()+a >@@? 6a(a 6)(i (an
6r)i.ia,
A 3
Sir*i H)6ai D)8*+6)naa )#8#
H)6aii Viru B -r*ni-
P* H)+a)+)i M),)na )#8#
Su6)8 Vari8)a, B,))(in/ A8i) /ra() III )#8# Sir*i
H)6ai D)8*+6)naa
Hi6*a,.u+in)+ia
Pani*6)nia -aua
Hi6)r6,)ni+)
1512201
;
P)raaan !ari9;
S 3 P)ru +)+.)ar 6)ru )raa 6)nu!
n")ri 6)ru >9? na9? +una! >9?# Ria"a +una! (ara! 2
+in//u "an/ ,a,u ()n/an 4*,u+) )-iar
500 88# A(a n")ri 6a(a anu aa BAB
ria"a BAB )n8)r arna !ia+ 2 +in//u
"an/ ,a,u ),a+a 2 !ari# Ria"a a-i
-unin/ >@? 12 a!un "an/ ,a,u# Ria"a
(ia.)) (an !i6)r)ni i(a- a(a#
Ria"a +inu+ a,-*!*, >9?# Ria"a
+)r*-*- >@? )7a- 5 a!un "an/ ,a,u )a6i
.)r!)ni )7a- +au- ru+a! a-i aa
+au (i*6)rai !)rnia = +in//u "an/ ,a,u
O 3 SSG$$M
P 3
Di) H)6ar II
In
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TD 3 120%0 ++H/
N 3 %:+)ni
P 3 20+)ni
S 3 =:: $
An >@? I- >@?
DVS R92 8+H2O
BP 3 V)i-u,)r BT 3 R! 99 ! 99
BJ 3 III +urni r)/u,ar BT >9?
A.( 3 P)ria,i- >@? -)an n*r+a,
H)6ar i(a- )ra.a ,i)n )ra.a
8!u@?
E- 3 E()+a >@@? 6a(a 6)(i (an
6r)i.ia,
A 3
Sir*i H)6ai D)8*+6)naa )#8#
H)6aii Viru B -r*ni-
P* H)+a)+)i M),)na )#8#
Su6)8 Vari8)a, B,))(in/
A8i) /ra() III )#8# Sir*i
H)6ai D)8*+6)naa
Hi6*a,.u+in)+ia
Pani*6)nia -aua
Hi6)r6,)ni+)
1:12201
;
P)raaan !ari9 5
S 3 P)ru +)+.)ar 6)ru )raa 6)nu!
n")ri 6)ru >9? na9? +una! >9?# Ria"a +una! (ara! 2
+in//u "an/ ,a,u ()n/an 4*,u+) )-iar
500 88# A(a n")ri 6a(a anu aa BAB
ria"a BAB )n8)r arna !ia+ 2 +in//u
"an/ ,a,u ),a+a 2 !ari# Ria"a a-i
-unin/ >@? 12 a!un "an/ ,a,u# Ria"a
(ia.)) (an !i6)r)ni i(a- a(a#
P 3
Di) H)6ar II
In
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Ria"a +inu+ a,-*!*, >9?# Ria"a
+)r*-*- >@? )7a- 5 a!un "an/ ,a,u )a6i
.)r!)ni )7a- +au- ru+a! a-i aa
+au (i*6)rai !)rnia = +in//u "an/ ,a,u
O 3 SSG$$M
TD 3 120%0 ++H/
N 3 %;+)ni
P 3 20+)ni
S 3 =:' $
An >@? I- >@?
DVS R92 8+H2O BP 3 V)i-u,)r BT 3 R! 99 ! 99
BJ 3 III +urni r)/u,ar BT >9?
A.( 3 P)ria,i- >@? -)an n*r+a,
H)6ar i(a- )ra.a ,i)n )ra.a
8!u@?
E- 3 E()+a >@@? 6a(a 6)(i (an
6r)i.ia,A 3
Sir*i H)6ai D)8*+6)naa )#8#
H)6aii Viru B -r*ni-
P* H)+a)+)i M),)na )#8#
Su6)8 Vari8)a, B,))(in/
A8i) /ra() III )#8# Sir*i
H)6ai D)8*+6)naa
Hi6*a,.u+in)+ia Pani*6)nia -aua
Hi6)r6,)ni+)
.**,!ari
Ren/ana Pemeri")aan
9 Fi.r*8an
RESUME
16
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S)*ran/ ,a-i9,a-i uia =& a!un +au- ru+a! a-i ()n/an -),u!an
6)ru +)+.)ar "an/ (ia,a+i )7a- 2 +in//u ).),u+ +au- ru+a!
a-i (iraa-an +)+.)ar 6)r,a!an9,a!an i(a- a(a n")ri 6)ru 8),ana
)raa +)n")+6i (an 6)ru )raa 6)nu!# Mua, (an +una! i(a- a(a
na+un ria"a +una! (ara! a(a 2 +in//u "an/ ,a,u ()n/an 4*,u+)
)-iar 500 88# Naaa+ +)
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!)6ai 6,)n*+)/a," (an a8i)# Hai, )n(*-*6i 3 4ari) )*
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TIN%AUAN PUSTAKA
SIROSIS HEPATIS
I. Ana(omi dan &i)iolo,i He+ar
Hai a(a,a! -),)n7ar )r.)ar (a,a+ u.u! .)ra raa9raa )-iar
1#500/r aau 2 .)ra .a(an *ran/ ()aa n*r+a,# L)a-n"a
).a/ian .)ar (i r)/i* !i6*-*n(ria ()-ra )6i/ari-a (an ).a/ian
-)8i, (i !i6*-*n(ria inira# Hai +)+i,i-i (ua ,*.u ua+a "aiu -anan
(an -iri# L*.u -anan (i.a/i +)n7a(i )/+)n an)ri*r (an 6*)ri*r
*,)!
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Hai +)+6un"ai
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8# M)a.*,i+) 6r*)in 3 ()a+inai aa+ a+in* 6)+.)nu-an ur)u+
unu- +)n/),uar-an a+*nia (ari 8airan u.u! 6)+.)nu-an
6r*)in 6,a+a )ra in)r-*n4)ri .)ra/a+ aa+ a+in* (an
in)i )n"aa ,ain (ari aa+ a+in*#
Penim#!nan *i(amin dan mineral
Via+in ,aru9,)+a- > ADEK ? (ii+6an (a,a+ !ai 7u/a 4ia+in B 12
)+.a/a (an .)i (a,a+ .)nu-
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aau (i!a+.a )8ara -i+ia *,)! !ai +),i6ui ir*-in (an )rua+a
)+ua !*r+*n )r*i( )6)ri )r*/)n -*ri*, (an a,(*)r*n#
Ha(i #er4!n,)i )e#a,ai ,!dan, darah dan 4il(ra)i
Hai a(a,a! *r/an 4)n*a "an/ +a+6u .)-)r7a ).a/ai )+6a
6)na+6un/an (ara! "an/ .)r+a-na aa 4*,u+) (ara! .)r,).i!an
(an +a+6u +)n"u6,ai (ara! )-ra (i aa -)-uran/an 4*,u+)
(ara!# Sinu*i( !ai +)ru6a-an ()6* (ara! "an/ +)n/a,ir -)+.a,i
(ari 4)na 8a4a >/a/a, 7anun/ -anan?# -)r7a
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P)n").a. (ari ir*i !)6ai an/a .an"a- na+un +a"*ria
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-A&TAR PUSTAKA
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