case kolesistolitiasis

8/13/2019 CASE Kolesistolitiasis

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BAGIAN ILMU BEDAH

FAKULTAS KEDOKTERAN

UNIVERSITAS HASANUDDIN

CASE PRESENTATION

SEPTEMBER 2013

KOLESISTOLITIASIS

OLEH :

M. KHUSMAN JAYA SAHIR

110.205.0138

PEMBIMBING :

Dr. ARWI AMIRUDDIN

SUPERVISOR :

Dr. MURNY A. RAUF, Sp.B-KBD (K)

DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK

DI BAGIAN ILMU BEDAH SUBDIVISI BEDAH DIGESTIF

FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN

MAKASSAR

2013


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LEMBAR PENGESAHAN

Yan !"r#an$a #anan $%!a&a' %n% "na#a*an !a'&a a'a+%+&a an !"r+an*#an

+"!aa% !"r%*#

Naa M. KHUSMAN JAYA SAHIR

NIM 110.205.0138

"/a' "n"/"+a%*an a+" r"+"n#a#%n $"nan $/ K/"+%+#/%#%a+%+, +"!aa% #a+

*"pan%#"raan */%n%* pa$a Ba%an I/ B"$a' $% Fa*/#a+ K"$*#"ran Un%4"r+%#a+

Ha+an$$%n.

MAKASSAR, SMBR 2013

M"n"#a'%,

Super!"#r

Dr. MURNY A. RAUF , Sp.B -KBD (K)

Pe$%!$%!&'

Dr. ARWI AMIRUDDIN


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CASE PRESENTATION

Ba%an I/ B"$a' D%"+#%6 Fa*/#a+ K"$*#"ran Un%4"r+%#a+ Ha+an$$%n Ma*a++ar

I( IDENTITAS PASIEN

Naa "n$"r%#a Nr'aa#%

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Aaa I+/a

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ana/ MRS 2082013

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II( FOTO KLINIS

III( AUTOANAMNESIS

)( Ke*u+)& U,)$) N"r% p"r# *anan a#a+

%( A&)$&e"!" Terp!$p!&


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IV( PEMERIKSAAN FISIS

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6r"%#+ *%r% +aa $"nan *anan

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V( PEMERIKSAAN PENUN.ANG

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PARAMETER NILAI RU.UKAN

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BAB II

TIN.AUAN PUSTAKA

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an "%/%*% *ran, !"n#* $an *p+%+% an !"r4ar%a+%.9


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Ba# p%"n ;*/a# !%a+ana $%#"*an $"nan *ran $%a"#"r *ran $ar% 1 ;,

!"r&arna ;*/a# *"*n%nan, /"!# $an +"r%n $%pa% $% $a"ra' A+%a.

Ba# %n% #"r!"n#* a*%!a# 6a*#r +#a+%+ $an %n6"*+% +a/ran "p"$. S#a+%+ $apa#

$%+"!a!*an *ar"na $%+6n+% +6%n#"r $$%, +#r%*#r, p"ra+% !%/%"r, $an para+%#. a$a

%n6"*+% "p"$, *"/"!%'an a*#%4%#a+ !-/;rn%$a+" !a*#"r% $an an+%a ("n$"n)

""an p"ran *n;% $a/a pa#"n"+%+ !a# p%"n pa$a pa+%"n $% n"ara #%r.

H%$r/%+%+ !%/%r!%n /"' "n=% #"r+"!# a*an "!"n#* !%/%r!%n #a*

#"r*na+% an a*an "n"n$ap +"!aa% ;a/;% !%/%r!%na#". n=% !-

/;rn%$a+" !a*#"r% !"ra+a/ $ar% *an . ;/% $an *an /a%nna $% +a/ran

"p"$. n=% %n% $apa# $%'a!a# /"' /;ar/a;#n" an *n+"n#ra+%na

"n%n*a# pa$a pa+%"n $"nan $%"# r"n$a' pr#"%n $an r"n$a' /"a*.1


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=(Ba# p%"n '%#a

Ba# #%p" %n% !ana* $%pa% pa$a pa+%"n $"nan '"/%+%+ *rn%* a#a

+%r+%+ 'a#%. Ba# p%"n %n% #"r#aa #"r$%r% $ar% $"r%4a# p/"r%="$ !%/%r!%n.

a#"n"+%+ #"r!"n#*na !a# p%"n %n% !"/ "/a+. Una !a# p%"n '%#a

#"r!"n#* $a/a *an$n "p"$ $"nan "p"$ an +#"r%/. Ba# "p"$ "n%+ %n%

na !"r*ran *";%/, '%#a $"nan p"r*aan an *a+ar. B%a+ana

!a# p%"n %n% "nan$n *ran $ar% 10 */"+#"r/.10


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n"r% a!$"n *rn%* !"r/an a#apn $%+p"p+%a. S#$% p"ra/anan p"na*%# +apa%

50 $ar% +"a pa+%"n $"nan !a# *an$n "p"$, #anpa "p"r#%!an*an

"n%+na, a$a/a' a+%#a#%*. Kran $ar% 25 $ar% pa+%"n an !"nar-!"nar

"pna% !a# "p"$ a+%#a#%* a*an "ra+a*an "a/ana an "!#'*an

%n#"r4"n+% +"#"/a' p"r%$" &a*# 5 #a'n. %$a* a$a $a#a an "r"*"n$a+%*an

*/"+%+#"*#% r#%n $a/a +"a pa+%"n $"nan !a# "p"$ a+%#a#%*.@

!. S%#a#%*

K"/'an #aana !"rpa n"r% $% $a"ra' "p%a+#r%, *a$ran *anan a#a+.

Ra+a n"r% /a%nna a$a/a' */%* !%/%"r an !"r/an+n /"!%' $ar% 15 "n%#, $an

*a$an !ar "n'%/an !"!"rapa a *"$%an. K/%* !%/%ar%+, n"r% pa+;a pran$%a/

*a$ran *anan a#a+, !%a+ana $%pr"+%p%#a+% /"' a*anan !"r/"a*, #"ra$% 30-70

"n%# +"#"/a' a*an, !"ra*'%r +"#"/a' !"!"rapa a $an *"$%an p/%', $%+"!a!*an

/"' !a# "p"$, $%r* +"!aa% */%* !%/%ar%+. Ma/ $an n#a' +"r%n *a/%

!"r*a%#an $"nan +"ranan */%* !%/%ar%+1,9

;. a+%"n $"nan *p/%*a+% !a# "p"$

K/"+%+#%#%+ a*# "rpa*an *p/%*a+% p"na*%# !a# "p"$ an pa/%n

$an +"r%n ""!a!*an *"$arra#an a!$"n, *'++na $%an#ara &an%#a +%a

p"r#"na'an $an an/a. "ra$anan a*# $ar% *an$n "p"$, !"r*a%#an $"nan

!+#r*+% $*#+ +%+#%*+ a#a $a/a %n6n$%!/.


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'ar;#, $%#a!a' +*, $an *"*a;aan "n#a/ a#a p"nrnan *"+a$aran +apa%

*a.

3

K/"$*/%#%a+%+ +"r%n "n%!/*an a+a/a' an +ana# +"r%+ *ar"na

*p/%*a+% "*an%* $an %n6"*+% an n*%n "nan;a na&a. Ba# $*#+

*/"$*+ $%+"r#a% $"nan !a*#"r!%/%a $a/a 95 p"r+"n pa+%"n +"r#a $"nan a$ana

!+#r*+% +a/ran "p"$, $apa# #%!/ */an%#%+ a*#.

p%+$" para' */an%#%+ a*# $apa# "n"!a!*an a!+"+ 'a#%. M%ra+% !a#

"p"$ *";%/ "/a/% ap/a 4a#"r% +"&a*# a$a +a/ran $%an#ara $*#+

*/"$*+ $%+#a/ $an $*#+ pan*r"a#%*+ $apa# "n"!a!*an pan*r"a#%#%+ !a#

"p"$. "r+an*#na !a# "p"$ $a/a ap/a a*an "n"!a!*an %*#"r+

!+#r*#%6.

D%an+%+ $an p"n"//aan an !a%* $an #"pa# $apa# "n;"a' #"ra$%na

*p/%*a+% an !"ra#. Kp/%*a+% $ar% !a# *an$n "p"$ an#ara /a%n */"+%+#%#%+

a*#, */"+%+#%#%+ *rn%+, */"$*/%#%a+%+, pan*r"a#%#%+, */an%#%+, +%r+%+ !%/%"r

+"*n$"r, %/"+ !a# "p"$, a!+"+ '"pa#%* $an p"r%#n%#%+ *ar"na p"r6ra+% *an$n

"p"$. Kp/%*a+% #"r+"!# a*an "p"r+/%# p"nanananna $an $apa# !"ra*%!a#

6a#a/.9

9( Pe$er!/"))& Pe&u&)&'

a. ""r%*+aan :a!ra#r%


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Ba# *an$n "p"$ an a+%#a#%* na #%$a* "nn**an

*"/a%nan pa$a p""r%*+aan /a!ra#r%. Apa!%/a #"ra$% p"ra$anan a*# $apa#

#"ra$% /"*+%#+%+, !%a+ana a*an $%%*#% *"na%*an r%nan !%/%r!%n +"r a*%!a#

p"n"*anan $*#+ */"$*+ /"' !a#. Ka$ar !%/%r!%n +"r an an #%n%

n*%n $%+"!a!*an /"' !a# $% $a/a $*#+ */"$*+. Ka$ar 6+6a#a+" a/*a/%

+"r $an n*%n *a$ar a/a+" +"r !%a+ana "n%n*a# +"$an +"#%ap *a/%

#"ra$% +"ranan a*#.

!. ""r%*+aan Ra$%/%+

F# p/+ a!$"n !%a+ana #%$a* "!"r%*an a!aran an *'a+ *ar"na

'ana +"*%#ar 10-15 !a# *an$n "p"$ an !"r+%6a# ra$%pa*. Ka$an

*an$n "p"$ an "nan$n "p"$ !"r*a/+% #%n% $apa# $%/%'a# $"nan

6# p/+ a!$"n. a$a p"ra$anan a*# $"nan *an$n "p"$ an "!"+ar

a#a '%$rp+, *an$n "p"$ *a$an #"r/%'a# +"!aa% a++a ar%nan /na*

$%*a$ran *anan a#a+ an "n"*an a!aran $ara $a/a ++ !"+ar, 6/">ra

'"pa#%;a.9,


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!%/%ar%+ /"!%' !a%*. K"*rananna a$a/a' a'a/ $ar% +"% !%aa $an !ana*

"n%!/*an r%+%* !a% pa+%"n. U/#ra+nra6% "pna% $"raa# +p"+%6%+%#a+ $an

+"n+%#%6%#a+ an #%n% n#* "n$"#"*+% !a# *an$n "p"$ $an p"/"!aran +a/ran

"p"$ %n#ra'"pa#%* apn "*+#ra'"pa#%*.

Ja $apa# $%/%'a# $%n$%n *an$n "p"$ an "n"!a/ *ar"na 6%!r+%+ a#a

$" *ar"na p"ra$anan apn +"!a! /a%n. Ba# an #"r$apa# pa$a $*#+

*/"$*+ $%+#a/ *a$an +/%# $%$"#"*+%, *ar"na #"r'a/an $ara $%$a/a ++. D"nan

/#ra+nra6% pn*# a*+% ra+a n"r% pa$a !a# *an$n "p"$ an

anr"n /"!%' "/a+ $ar% pa$a $"nan pa/pa+% !%a+a.


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'"pa#%#%+ *ar"na pa$a *"aa$aan #"r+"!# *n#ra+ #%$a* $apa# "n;apa% 'a#%. "n%/a%an

*/"+%+#ra6% ra/ /"!%' !"ra*na pa$a p"n%/a%an 6n+% *an$n "p"$.

9,


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R %n% "$a'*an 4%+a/%+a+% /an+n +#*#r !%/%"r $an "$a'*an a*+"+ *"

$a/a $*#+ */"$*+ !a%an $%+#a/ n#* "na!%/ !a# "p"$, +"/a%n %#

R !"r6n+% n#* "!"$a*an %*#"r+ an $%+"!a!*an /"' p"na*%# 'a#%,

%*#"r+ '"pa# +"//"r $"nan %*#"r+ an $%+"!a!*an /"' !+#*+% !%/%"r $an a

$apa# $%na*an n#* "n"/%$%*% "a/a a+#r %n#"+#%na/ pa$a pa+%"n-pa+%"n an

*an$n "p"$na +$a' $%an*a#. R %n% !"r%+%* #"ra$%na #an$a-#an$a

p"r6ra+% a#a %n6"*+%.9,


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M"#$" %n% $%$a+ar*an pa$a pr%n+%p ("r;#an"+ #ran+'"pa#%;

;'/an%ra) $an %n+#%/a+% /an+n p"/ar# */"+#"r/ *"*an$n "p"$.

M"+*%pn p"na/aan a+%' #"r!a#a+, %n6+ p"/ar# */"+#"r/ an p#"n ( "#%/-#"r-

!#%/-"#"r (MB) ) *" $a/a *an$n "p"$ "/a/% *a#"#"r an $%/"#a**an

p"r*#an #"/a' #"r/%'a# "6"*#%6 $a/a "/ar#*an !a# "p"$ pa$a pa+%"n-pa+%"n

#"r#"n#. r+"$r %n% %n4a+%6 $an *"r%an #aana a$a/a' an*a *"*a!'an an

#%n%.2

=6(:%##r%p+% (>#ar;r4ra/ S';* Wa4" :%#'#r%p+ O SW:)

:%##r%p+% "/!an "/"*#r +* "+*%pn +ana# pp/"r !"!"rapa #a'n

an /a/, ana/%+%+ !%aa an6aa# pa$a +aa# %n% 'ana #"r!a#a+ n#* pa+%"n an

!"nar-!"nar #"/a' $%p"r#%!an*an n#* "na/an% #"rap% %n%. 6"*#%6%#a+ SW:

""r/*an #"rap% a$4an# a+a r+$"*+%/a#.10


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M$%6%*a+% $ar% #%n$a*an */"+%+#"*#% #"r!*a $"nan %n+%+% /"!%' *";%/

$"nan "6"* n"r% pa+;a p"ra+% /"!%' r"n$a'.

1,7

( Pr#'"!"

a$a */"+%+#/%#%a+%+ +"n$%r% #%$a* p"r/ $%'!n*an $"nan "n%n*a#na

*"a#%an a#a $%#an$a% $"nan *";a;a#an. Baa%anapn !%+a $%+"!a!*an *ar"na

a$ana *p/%*a+%. Ja$% prn+%+ */"+%+#/%#%a+%+ #"ran#n $ar% a$a a#a #%$a*na

*p/%*a+% $an !"ra# a#a r%nanna *p/%*a+%. Nan, a$ana %n6"*+% $an

'a/anan $%+"!a!*an /"' !a# an !"ra$a $%$a/a +a/ran !%/%ar%+ +"'%na $apa#

"nan;a %&a. Wa/apn $"%*%an, $"nan $%an+%+ $an p"n!a#an an ;"pa#

+"r#a #"pa#, 'a+%/ an $%$apa#*an !%a+ana +ana# !a%*.9,,10

BAB III

RINGKASAN

K/"/%#%a+%+ a#a !a# "p"$ "rpa*an p"na*%# an ;*p +"r%n

$%$"r%#a /"' &an%#a, #"r#aa +%a an#ara 20-70 #a'n. Ba# "p"$ na

$%!"$a*an "na$% 3 "n%+, a%# !a# */"+#"r/, !a# !%/%r!%n a#a !a# p%"n

;*/a# $an !a# p%"n '%#a.

Ba# */"+#"r/ "rpa*an an #"r+"r%n $%#"*an, $"nan *an$nan

*/"+#"r/ /"!%' $ar% 90. Ba# "p"$ $apa# $%#"*an $% $a/a *an$n "p"$

%# +"n$%r%, a#a $apa# a $%#"*an $%+a/ran-+a/ran "p"$, +"p"r#% $*#+


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+%+#%*+ a#a $*#+ */"$*+. S"*%#ar 80 pa+%"n $"nan !a# "p"$, !%a+ana

a+%#a#%+.

S"$an*an pa$a an +%#a#%*, *"/'an #aana !%a+a !"rpa n"r% $%

$a"ra' "p%a+#r%, *a$ran *anan a#a+ a#a pr"*r$%, $an */%* !%/%"r. "n"!a!

$ar% !a# "p"$ %n% !"/ $%*"#a'% +";ara pa+#%, #"#ap% $%p"r*%ra*an a$a 3 6a*#r

pr"$%+p+%+% #"rp"n#%n, a%#


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DAFTAR PUSTAKA

1. :"+ana :. Ba# p"$ $a/a B* Aar "na*%# Da/a J%/%$ 1. $%+%

I.Ja*ar#a Ba/a% "n"r!%# Fa*/#a+ K"$*#"ran Un%4"r+%#a+ In$n"+%a.

2009.@9 @81.

2. :!an#!%n S. M, ""r%*+aan 6%+%* $an M"n#a/, Ja*ar#a Fa*/#a+

*"$*#"ranUn%4"r%#a+ In$n"+%a, 18.

3. Brnn"r+$$ar#, K"p"ra&a#an"$%;a/ !"$a' / 2. Ja*ar#a.


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