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Scenario F Blok 24

Mrs. Tari, 37 years old, from middle income family comes to doctor at a public healty center

ith chief complain of !a"inal bleedin". She e#perienced post coital bleedin" for one month.

Since one years a"o she has been complainin" about !a"inal dischar"e ith smelly odor and

sometimes accompanied by !ul!ar itchy. She already has to children before and the youn"est

child is si# years old. $er husband is a truck dri!er. She has ne!er "one to the doctor relatied to

her ccomplain about !a"inal dischar"e, not usin" any medication, no history of papsmear

e#amination, and no history of $%& !accination. She has a history of usin" intrauterine de!ice

'()*+ as contraception for fi!e years since her youn"est child birth and the ()* has been

remo!e one year a"o. $er older sister died to years a"o cause by breast cancer.

ou act as the doctor in public health center and be pleased to analyse this case.

(n the e#amination findin"s-

$ei"ht- // cm, ei"ht- /0 k"

Blood preasure- 2010 mm$", pulse- 0 #1menit, - 20 #menit

%alpebral conun"ti!a- anemic

Breast- there as no mass on both mammae

5bdomen- flat and souffl6, symmetric, uterine fundus in not palpable, there are no mass, no

painful tenderness and no free fluid sin".

(nternal e#amination

(nspection- !ul!a and uretra as normal, there as no mass on the !ul!a, urethra, hymen and

perineum.

Speculum e#amination- mass on the portio sie 2#2 cm, e#ophytic, fra"ile, easy to bleed, no

infiltration to the !a"ina, flour 8

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Bimanual e#amination- ser!i# is soft, the e#ternal os is closed, no cer!ical motion tenderness,

e#ophytic mass sie 2#2# c,.fra"ile easy to bleed, no infiltration to the !a"ina, uterine sie in

normal, both adne#a and parametrium are ithin" normal limit.

Then you performed &(5, the resukt as you could define the e#ternal os, s9uamous columnar

unction and there ar thick acetohite epithelium at the 2 o:clock untile / o:clock position, so

you performed biopsy.

;aboratorium result- $b ,3 "r1d; < =B> 2.0001mm < thrombocyte 770.0001mm3< ?S 0

mm1hour

The ne#t eek, the patient come ith the histophatolo"y result @ s9uamous cell carcinoma

moderate differentiation, ithout limpho!ascular space in!asionA. ou "a!e the informed

concent to the patient and family to refer her to the hospital, she asked you the dia"nosis, kind of

e#amination that ill be performed to her, and the possible treatment.

(. larifikasi(stilah

. &a"inal bleedin" -perdarahan yan" melalui !a"ina termasukperdarahan yan"

daridindin" !a"ina ataudari or"an "enitalia lainnya.2. $%& - human papilloma !irus adalah !irus yan" men"infeksi area kulitdan

or"an kelamin.

3. ()* -sebuahalatkontrasepsi yan" berupakomponenkecilpanan"nya cm

dimasukankedalamrahimuntukmence"ahkehamilan.

4. %ap smear

-prosedurpearnaansitolo"ise#foliatifuntukmendeteksidanmendia"nosisberba

"aikondisiterutamakondisike"anasandanprake"anasanpadatraktus "enitalia

anita./. Souffle -suaraauskultasi yan" terden"arsepertimeniup.

C. 5cetohite -kilauberarnakeputihan di permukaanepitel.

7. ?#ophytic -berkaitanden"anpertumbuhan tumor luar ,

berkemban"biakpadaepitel e#terior ataupermukaan or"an ataustruktut lain

dimanapertumbuhanberasal.

((. (dentifikasiMasalah

. Dy, Tari, 37 tahun,

darikeluar"apen"hasilanmenen"ahdatan"kedokterden"ankeluhanutamaperdarahan

!a"ina.

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2. %asienmen"alamipendarahanpascacoituselama bulan. Seaksetahun yan"

lalupasienmen"eluhadasekret di !a"ina den"anbaubusukdanterkadan"disertai rasa

"atalpada !ul!a.

3. %asiensudahmemiliki 2 anak, yan" palin" mudaberusia C tahun.

Suamipasienseoran"supirtruk.akakperempuanpasienmenin""al 2 tahun yan"

lalukarenakankerpayudara.

4. %asientidakpernahberobatkedokterterkaitkeluhantentan"sekret !a"ina,

tidakmen""unakanobatEobatan, tidakadariayatpemeriksaan pap

smeerdantidakadariayat!aksinasi $%&. %asienmemilikiriayatmen""unakan

()* selama / tahunseakkelahirananakterakhirdansudahdilepas tahun yan" lalu.

/. (n the e#amination findin"s-

$ei"ht- // cm, ei"ht- /0 k"Blood preasure- 2010 mm$", pulse- 0 #1menit, - 20 #menit

%alpebral conun"ti!a- anemicBreast- there as no mass on both mammae

5bdomen- flat and souffl6, symmetric, uterine fundus in not palpable, there are no

mass, no painful tenderness and no free fluid sin".

;aboratorium result- $b ,3 "r1d; < =B> 2.0001mm < thrombocyte

770.0001mm3< ?S 0 mm1hour.

C. (nternal e#amination(nspection- !ul!a and uretra as normal, there as no mass on the !ul!a, urethra,

hymen and perineum.

Speculum e#amination- mass on the portio sie 2#2 cm, e#ophytic, fra"ile, easy to

bleed, no infiltration to the !a"ina, flour 8.

Bimanual e#amination- ser!i# is soft, the e#ternal os is closed, no cer!ical motion

tenderness, e#ophytic mass sie 2#2# c,.fra"ile easy to bleed, no infiltration to

the !a"ina, uterine sie in normal, both adne#a and parametrium are ithin"

normal limit.7. Then you performed (&5, the result as you could define the e#ternal os,

s9uamous columnar unction and there ar thick acetohite epithelium at the 2

o:clock untile / o:clock position, so you performed biopsy.

The ne#t eek, the patient come ith the histophatolo"y result @ s9uamous cell

carcinoma moderate differentiation, ithout limpho!ascular space in!asionA. ou

"a!e the informed concent to the patient and family to refer her to the hospital,

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she asked you the dia"nosis, kind of e#amination that ill be performed to her,

and the possible treatment.

(((. 5nalisisMasalah

. Dy, Tari, 37 tahun, dari keluar"a pen"hasilan menen"ah datan" ke dokter den"an

keluhan utama perdarahan !a"ina.

a. 5pa hubun"an usia, sosio ekonomi den"an kasus 'puput, frischa+

b. 5pa etiolo"i dan mekanisme pada perdarahan !a"ina 'har!inder, alek+c. Ba"aimana cara membedakan perdarahan !a"ina fisiolo"is dan patolo"is

'dea, riana+

2. %asien men"alami pendarahan pasca coitus selama bulan. Seak setahun yan"

lalu pasien men"eluh ada sekret di !a"ina den"an bau busuk dan terkadan"

disertai rasa "atal pada !ul!a.

a. Ba"aimana etiolo"i dan mekanisme perdarahan pasca coitus 'sakty, 5r!in+b. Ba"aimana etiolo"i dan mekanisme sekret di !a"ina den"an bau busuk dan

disertai rasa "atal pada !ul!a 'theo, mathius, oop+

c. Ba"aimana riayat peralanan penyakit 'monic. 5ri+

3. %asien sudah memiliki 2 anak, yan" palin" muda berusia C tahun. Suami pasien

seoran" supir truk. akak perempuan pasien menin""al 2 tahun yan" lalu karena

kanker payudara.a. Ba"aimana hubun"an riayat obstetri den"an kasus 'dea, riana+

b. 5pa hubun"an riayat pekeraan suami den"an kasus 'har!inder, alek+

c. 5pa makna klinis dari kakak perempuan menin""al karena kanker

payudara 'har!inder, alek+

4. %asien tidak pernah berobat kedokter terkait keluhan tentan"s ekret !a"ina, tidak

men""unakan obatEobatan, tidak ada riayat pemeriksaan pap smear dan tidak

ada riayat !aksinasi $%&. %asien memiliki riayat men""unakan ()* selama

/ tahun seak kelahiran anak terakhir dan sudah dilepas tahun yan" lalu.

a. 5pa makna klinis dari pasien tidak pernah berobat ke dokter terkait keluhan

tentan" sekret !a"ina, tidak men""unakan obatEobatan, tidak ada riayat

pemeriksaan pap smear dan tidak ada riayat !aksinasi $%& 'theo, matius,

oop+b. 5pamaknaklinisriayatpen""unaan ()* padakasus 'monic, ari+

/. (n the e#amination findin"s-$ei"ht- // cm, ei"ht- /0 k"

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Blood preasure- 2010 mm$", pulse- 0 #1menit, - 20 #menit

%alpebral conun"ti!a- anemic

Breast- there as no mass on both mammae5bdomen- flat and souffl6, symmetric, uterine fundus in not palpable, there are

no mass, no painful tenderness and no free fluid sin".

;aboratorium result- $b ,3 "r1d; < =B> 2.0001mm < thrombocyte

770.0001mm3< ?S 30 mm1hour.a. Ba"aimana interpretasi dan mekanisme abnormal dari pemeriksaan diatas

'puput, frischa+

C. (nternal e#amination(nspection- !ul!a and uretra as normal, there as no mass on the !ul!a,

urethra, hymen and perineum.Speculum e#amination- mass on the portio sie 2#2 cm, e#ophytic, fra"ile, easy

to bleed, no infiltration to the !a"ina, flour 8.

Bimanual e#amination- ser!i# is soft, the e#ternal os is closed, no cer!ical

motion tenderness, e#ophytic mass sie 2#2# c,.fra"ile easy to bleed, no

infiltration to the !a"ina, uterine sie in normal, both adne#a and parametrium

are ithin" normal limit.

a. Ba"aimana interpretasi dan mekanisme abnormal daripemeriksaan di atas

'dea, riana+

7. Then you performed (&5, the result as you could define the e#ternal os,

s9uamous columnar unction and there ar thick acetohite epithelium at the 2

o:clock untile / o:clock position, so you performed biopsy.

The ne#t eek, the patient come ith the histophatolo"y result @ s9uamous cell

carcinoma moderate differentiation, ithout limpho!ascular space in!asionA.

ou "a!e the informed concent to the patient and family to refer her to the

hospital, she asked you the dia"nosis, kind of e#amination that ill be performed

to her, and the possible treatment.

a. Ba"aimana interpretasi dan mekanisme abnormal dari pemeriksaan di atas

'sakty, 5r!in+

b. Ba"aimana cara pemeriksaan (&5 'puput, frischa+

c. Ba"aimana "ambaran histopatolo"inya 'theo, matius, oop+

. 5nalisis5speklinis

a. Ba"aimana cara pene"akan dia"nosis pada kasus 'dea, riana+

b. ** 'monic, ari+

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c. =* dandefinisi 'shakty, 5r!in+

d. ?tiolo" 'har!in, alek+

e. ?pidemiolo"i 'har!inder, alek+f. Faktorresiko 'puput, frischa+

". %atofisiolo"i 'monic, ari+

h. Manifestasiklinis 'shakty, 5r!in+i. %enatalaksanaan 'theo, matius, oop+

. omplikasi 'dea, riana+

k. %ro"nosis 'shakty, 5r!in+l. S*( semuanya

;earnin" (ssue

. >a ser!i#'puput, frischa, har!inder, alek, monic, ari+

2. $%& 'sakty, 5r!in, theo, oop, matius, dea, riana +

$ipotesis

Dy. Tari, 37 tahun men"alami pendarahan !a"ina akibat karsinoma se!i#.