Slide Tumor Gaster

8/17/2019 Slide Tumor Gaster

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TUMOR GASTERPRAJOGO KUSUMA

C111 11 157



ANAMNESIS

Identitas:

Nama : Tn. LM

Jenis kelamin : Laki-laki

Usia : 54 a!"n

N#m#$ RM : 7%%&'&

Tan((al mas"k: %4-&-%)15



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(.



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



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



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( : ;-<



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



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



"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#;-<



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



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



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



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



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 %



& '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$





(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



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.



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



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.



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 '.



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$#sa *a(ian l"a$



=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.



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



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(



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)



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



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.



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



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



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



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



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



Klasi)kasi







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



TER>MA KAS>

Slide Tumor Gaster

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