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CHAPTER I

INTRODUCTION

Abdomen elargement is common complaints that bring patients to the hospital

for treatment. Complaints abdominal bloating can be caused by several mechanisms,

among others, the body can be caused by an infection, circulatory disorders,

neoplasms, and abnormal blood cells. Growing stomach can also be caused by

enlargement of intra-abdominal organs, such as liver and spleen.

The mechanism causing abdominal bloating due to infection, spleen size slightly

enlarged. Enlargement occurs due to inflammation that causes an increase in the

infiltration of phagocytic cells and neutrophil cells. In chronic non-pyogenic

infection, enlargement happens to exceed the size of the spleen in abdominal bloating

in acut mechanism. Infection caused by circulatory disorders can also cause

congestion in the blood vessels of the spleen. Spleen congestion condition can be

caused by two main conditions, like congestive heart failure (CHF / Congestive Heart

Failure) and cirrhosis of the liver (Hepatic cirrhosis). Conditions of heart failure

(dilated) cause general congestion or systemic, especially the portal vein and the

hepatic vein of splen. This situation resulted in increased hydrostatic pressure of vein

and resulting in an enlarged spleen. On the condition of liver cirrhosis, blood flow in

the portal vein obstruction, due to liver fibrosis. These circumstances lead to an

increase in hydrostatic pressure of portal vein, causing enlargement due to neoplasms

mechanism can be primary and secondary. In the primary condition, oncogenic cellsin primary spleen cells grow into tumors. Secondary condition generally occurs

because of the influence (metastatic) tumor cell lymphoma and leukemia. Enlarged

abdomen can be caused by a blood disorder can be caused by the production of

abnormal blood cells for example in cases of hemolytic anemia is idiopathic

thrombocytopenia), in leukemia and lymphoma , as well as the chronic bone marrow

failure due to fibrosis or secondary cell infiltration tumor.

Chronic myelogenous leukemia (miyeloid cronic leukemia)

CML is a disease pluripotent stem cells are characterized by the presence of

anemia, blood granulocytosis extreme, granulocytic immaturity, basofilia, and

frequently also thrombocytosis, and splenomegaly. Chronic myelogenous leukemiaincidence reached 20% of all leukemias in adults, second only to chronic lymphocytic

leukemia. In general attack aged 40-50 years, can be found at a young age and

usually progressive. Can also occur in children Juvenile forms of CML and CML was

found to be 15-20% of leukemia which is the most common leukemia in Indonesia.

Incidence increased in Japan after the atomic bombs on Nagasaki and Hiroshima, and

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similarly occurred in Russia after the atomic reactor Chernobi.

CML is a suspected cause of the 22q chromosomal abnormalities or partial loss of the

long arm of chromosome 22, which is currently known of Philadelphia chromosome(Ph), in addition to the excessive proliferation of stem cells in the system

hematopoesis pluropoten. These clones in addition to excessive ploriferasinya can

also survive longer than the normal cells, because BCR-ABL gene on chromosome

Ph is apoptosis. Clinical symptoms of CML is the patient complained of an enlarged

spleen or feeling full quickly due to the insistence of the spleen to the stomach.

Sometimes there is pain such as stomach squeezed the top right. Another frequent

complaint is not specific, sense of fatigue, weak body, which is not very high fever,

night sweats. Weight loss occurs after the long disease progresses, thats reason we

choose this case to present is to more information about CML and can be diagnose

early.