Presentasi Kasus II

8/16/2019 Presentasi Kasus II

http://slidepdf.com/reader/full/presentasi-kasus-ii 1/46

PRESENTASI KASUS IIPERDARAHAN DENGAN

BERBAGAI SEBAB

Dewi Hanifa Primanelza

03.011.073

KEPANITERAAN KLINIK ILMU KESEHATANANAK

PERIODE 11 APRIL 1! "UNI #01$RUMAH SAKIT UMUM DAERAH %UDHI ASIH

&AKULTAS KEDOKTERAN UNI'ERSITAS TRISAKTI



Pen(a)*l*an



STATUS PASIEN I• La+i,la+i- 1# a)*n

• %en/+a+ a(a +e(*a +ela+ maa 2ea+ 3 )ari SMRS

• %en/+a+ im4*l men(a(a+- menea (an erama +ali a(a

a/i )ari

• Demam men(a(a+ in//i- (i2erai men/i/il

• S*(a) (i4ai nam*n +el*)an 4en/+a+ a(a +ela+ ma2i)

a(a

• %AK 2e(i+i (an air kencingnya berwarna seperti air

cucian daging

•

Ter(aa 4a*+- ile+ (an 2a+i en//r+an

5m2 meni2- ama+ 2a+i 2e(an/- +e2an /izi +*ran/- TD1306!0 mmH/- N !!6meni- P #06meni (an S 3$.!85. Pa(aemeri+2aan waa) (i(aa+an edema palpebra ++!Pemeri+2aan a4(men (i(aa+an 2*el- n9eri e+an :,;-

4allemen :,6,;- n9eri +e+ 5'A :,6,;

ANAMNESIS

P&



Pemeri+2aan Pen*nan/





Dia/n2i2

DIAGN"SISBANDING

•S*2e< =NA,PS

• ISK (en/a Hieren2i=ra(e I

• Sin(rm Nefri+

DIAGN"SIS#ER$A

•S*2e<=lmer*lnefrii2A+* a2<a infe+2i2re<<<*2



Pemeri+2aan An*ran

Mnir *rine len/+a er 3 )ari

Pemeri+2aan ASTO

Pemeri+2aan ele+rli- LED

Pemeri+2aan al4*min (an /l4*lin (ara)

Pemeri+2aan +le2erl

K*l*r *rin

Pemeri+2aan 2er*m +mlemen 53-5>



Taala+2ana

N%n&'edikament%sa

• KIE a(a

ran/*a a2ien• Tira) 4arin/• Mnir *rine

**6#> am- TD- (i*re2i2• Die ren(a)

/aram

'edikament%sa

• 'en?n• Ine+2i

<efaime # 1 /ram I.'

• Ine+2if*r2emi( # 30 m/ I.'

• 5aril 3 1#-@ m/ P.O



Pr/n2i2

A( iam

• A(

%nam

A(

f*n<inam

• D*4ia a(

4nam

A(

2anainam

• D*4ia a(

4nam



STATUS PASIEN II

• Perem*an- 13 a)*n

• Demam 2ea+ @ )ari SMRS

• Demam (ira2a+an menea- in//i- (i2erai ra2a men//i/il

• M*na) 2e4an9a+ 1- i2i <airan warna 4enin/ (an ma+anan

• N9eri +eala )e4a (an n9eri (i4ela+an/ maa

•

S*(a) (i4ai nam*n +el*)an i(a+ 4er+*ran/• %el*m %A% 2ea+ 1 min//* SMRS

• Gusi berdara(

ANAMNESIS

5m2 meni2- ama+ 2a+i 2e(an/- +e2an /izi 2*er 4e2- TD 100670 mmH/- N !>6meni- P #>6meni (an S [email protected](a emeri+2aan m*l* (i(aa+an muk%sa gusi tampakada dara( Pemeri+2aan a4(men (i(aa+an er* 4*n<i-

2*el- n9eri e+an :,;- Hear (an lien 2*li era4a

P&



Pemeri+2aan Pen*nan/:1>6>;

P P



Pemer 2aan Pen*n an/:1@6>;



Dia/n2i2

DIAGN"SISBANDING

•Den/*e &eer

• DH& /ra(e II• Demam ifi(

DIAGN"SIS#ER$A

•Den/*e Hemra/i<&eer /ra(e II



Pemeri+2aan An*ran

Pemeri+2aan (ara) B Mnir H4- H-Le+2i- Trm42i er )ari

S=OT6S=PT

I/M6I/= Den/*e

& )ra+2 RLD

T*4e



Taala+2ana

N%n&'edikament%s

a

• KIE a(aran/*aa2ien

• O42era2ian(a ial

• Min*m 9an/

4an9a+

'edikament%sa

• I'&D A2erin/ 3<<6+/446am

• Para<eaml 3 @00 m/ :+6;

• Am4rl 3 1 <) P.O



Pr/n2i2

A( iam

• D*4ia

A(

f*n<inam

• A(

%nam

A(

2anainam

• D*4ia a(

4nam



STATUS PASIEN III

• Perem*an- 10 a)*n

• Demam nai+ *r*n 2ea+ $ )ari SMRS

• Demam im4*l men(a(a+ in//i (an nai+ *r*n. T*r*n a(a

a/i )ari

• M*na) 2e4an9a+ #- i2i <airan warna 4enin/ (an ma+anan-

C 1 2en(+ ma+an• N9eri +eala )e4a- n9eri (i4ela+an/ maa- m*al- 4a(an

e/al

• N9eri *l* )ai- ana+ erli)a lema2

• Tan/an (an +a+i 4er+erin/a 4a2a) (an (in/in

• %AK +*ran/ lan<ar- 2e(i+i- era+)ir am 0#.00 (ini )ari

• Mimi2an #

ANAMNESIS



5m2 meni2- ama+ 2a+i 2e(an/- +e2an /izi 2*er 4e2- TD 100670 mmH/- N 1#06meni lema)- i2i +*ran/- P3#6meni (an S 3$.@85. Pa(a emeri+2aan m*l* (i(aa+anmuk%sa gusi tampak ada dara( Pemeri+2aan m*l*(i(aa+an 4i4ir +erin/. Pemeri+2aan a4(men (i(aa+an2*el- n9eri e+an :; (i re/i )in+n(ri*m +anan (anei/a2ri*m. Hear era4a mem4e2ar 163 163- ei aam-+n2i2en2i +en9al- erm*+aan li<in. Pa(a emeri+2aane+2remia2 (i(aa+an a+ral (in/in a(a +eema

e+2remia2- 5RT #2

P&



Pemeri+2aan Pen*nan/:#06$;



Pemeri+2aan Pen*nan/:#16$;



Dia/n2i2

DIAGN"SISBANDING

•DSS (en/aner4ai+an

• DH& /ra(e III

DIAGN"SIS#ER$A

•DSS (en/aner4ai+an





Taala+2ana

N%n&'edikamen

t%sa

• KIE a(aran/*a

a2ien•O42era2ian(a-

(i*re2i2 (an

'edikament%sa

• O+2i/eni2a2i• A2erin/ @

<<6+/%%6am a2<a

re2*2ia2i• Pa2an/ D5- N=T• In Ranin ##@ m/

I.'

• Para<eaml 3@00



Pr/n2i2

A( iam

• D*4ia

A(

f*n<inam

• D*4ia

A(

2anainam

• D*4ia a(

4nam

STATUS PASIEN I'



STATUS PASIEN I'

• La+i,la+i- 1 a)*n 3 4*lan

• %A% 4er(ara) 2ea+ 1 )ari SMRS

• # )ari 2e4el*mn9a- a2ien (iare- i2i <air len(ir (an ama2-

+*nin/,)ia*- $- C16# aF*a /ela2

•

D*4*r a2ien erli)a mera) +ei+a (i4er2i)+an• M*na) )an9a 1- i2i 2*2* *i) 9an/ (imin*m

• 1 )ari 2e4el*mn9a- (iare 4er(ara)- >- mera) 2e/ar- C16#

2en(+ +e<il- (ara) 4er<am*r (en/an fe2e2

• Demam (i2an/+al

• Pa2ien erli)a )a*2 (an air maa i(a+ +el*ar 2aa menan/i2

ANAMNESIS



5m2 meni2- ama+ 2a+i 2e(an/- +e2an/izi nrmal- N 13>6meni +*a i2i <*+*- P

3>6meni (an S 3$.>85. Pa(a emeri+2aanwaa) (i(aa+an maa <e+*n/ 6- 4i4ir+erin/ :;. Pa(a emeri+2aan an/enial(i(aa+an a(an9a eriema na*m

P&



:#!6>;







DIAGN"SISBANDING

• Diare a+*-

(e)i(ra2i rin/an,2e(an/ e.< infe+2i4a+eri

• Diare a+*-

(e)i(ra2i rin/an,2e(an/ e.< infe+2iir*2

• Eriema na*m

e.< inleran2i

DIAGN"SIS#ER$A

• Diare a+*-(e)i(ra2irin/an,2e(an/e.< infe+2i

4a+eri• Eriemana*m e.<inleran2i



Pemeri+2aan An*ran

Pemeri+2aan la+2a (en/an +era2la+m*2

Mnir H4- H- Le*+- Trm4 er )ari

Pemeri+2aan fe2e2 len/+a *lan/



Taala+2ana

N%n&'edikament%

sa

• KIEa(aran/*aa2ien

• O42era2ian(a ial(an +el*)an

• Tira) 4arin/

'edikament%sa

• I'&D A2erin/ 3<<6+/%%6am

• Pr4i+i( 1 1

2a<)• Ine+2i/enami2im 3

#@ m/ i



Pr/n2i2

A( iam

• A(

4nam

A(

f*n<inam

• D*4ia a(

4nam

A(

2anainam

• D*4ia a(

4nam

STATUS PASIEN I'



STATUS PASIEN I'

• La+i,la+i- 3 a)*n G 4*lan

• R*am,r*am +emera)an 2ea+ > )ari SMRS

• R*am erama +ali m*n<*l (i a)a +anan lal* men9e4ar +e

+e(*a *n/+ai- (an +e(*a an/an

• R*am (ira2a+an n9eri (an /aal

• > )ari SMRS- m*na #,36)ari- i2i ma+anan (an <air- /ela2

aF*a- 2eia )a4i2 ma+an

• Demam 2*men/,2*men/

• %en/+a+ a(a +e(*a +a+i

ANAMNESIS



5m2 meni2- ama+ 2a+i 2e(an/- +e2an

/izi nrmal- TD G06$0 mmH/- N G$6meni- P#>6meni (an S 3$.>85. Pa(a emeri+2aane+2remia2 (i(aa+an *r*ra m*lile9an/ (aa (ira4a- *+*ran miliar )in//an*m*lar- 4en*+ i(a+ era*r a(a a)a-4ei2- len/an aa2. E(ema :6;

P&

P i+ P



Pemeri+2aan Pen*nan/:#$6>;



Pemeri+2aan Pen*nan/



Pemeri+2aan Pen*nan/:#76>;





DIAGN"SISBANDING

• Henoch-Schonlein

Purpura• Hier2en2iiia2

a2+*lii2• Immune

thrombocytopenic purpura :ITP;

• Infe+2i Sal*ranKemi)

DIAGN"SIS#ER$A

• Henoch-Schonlein

Purpura• Infe+2iSal*ran

Kemi)



Pemeri+2aan An*ran

Pemeri+2aan fe2e2 r*in

Pemeri+2aan +a(ar I/A 2er*m

K*l*r *rin

%i2i +*li



Taala+2ana

N%n&'edikamen

t%sa

•KIE a(aran/*a

a2ien

'edikament%sa

• In 5efaime 3 >00 m/

• In Ranin 3 >00 m/

• Pre(ni2n 3 @m/

• Para<eaml >



Pr/n2i2

A( iam

• A(4nam

A(

f*n<inam• D*4ia a(

4nam

A(

2anainam• D*4ia a(

4nam



Tina*an P*2a+a

•A(an9a em4en*+an+mle+2 im*n-

4er2ir+*la2i- men/en(a(i /inal- era(i/an//*an lra2i

/lmer*l*2- im4*l

=lmer*lnefrii2A+*



•A+i4a a(an9arm42ienia-

en*r*nan fa+rem4e+*an- +elainanf*n/2i rm42i (an

+er*2a+an (in(in/

D%D (an DSS



•A(an9a /an//a*nr2e2 a42r2i (an

2e+re2i <airan-ele+rli (i 2al*ran

Diare A+*

Documents

Presentasi Kasus II