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Case Based DiscusionAdviser : dr. H.M. Saugi Abduh,Sp.PD

PUPUT SUSIL!ATI"#.$"%.&&'(

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Patient Identity

)a*e : Mr. !

Age : &$ +ears od

Se- : *ae

 ob :

/eigion: Mose*

S0a0us : priva0e

)o. /M : "#$(&$1#

/oo* : Bai0u I22ah #

3n0r+ Da0e : Sep0e*ber , 1"0h $"#&

3-i0 Da0e : c0ober , 40h $"#&

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Pa0ien0s ca*e 0o e*ergenc+ roo* /SI

su0an agung 5i0h dispneu. $ 5ee6s ago, Heco*pained d+spneu, cough, hear0papi0a0ion and so*e0i*es epigas0ric pain.

I0 can reie7 5hen he is a+ing on ha7 si0posi0ion. he aso 7e0 0he d+spneu 5hen

a5a6en sudden+ a0 *ide o7 nigh0.

!i0h a 0hings

happened 0o hi*,He haven80 ge0 an+*edica0ion.

D+spneu happened

5hie He 5as in *idac0ivi0+ such as

s5eaping.

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His0or+ o7 iness

History of

previous illness:• His0or+ sa*e iness 9;• H+per0ension his0or+ 9

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S+s0e*a0ic Ana*nesis =enera : 5ea6S6in : nor*aHead : nor*a3+es : nor*a3ars : nor*a

)ose : nor*aMou0h : nor*a Throa0 : nor*a)ec6 : nor*aChes0 : nor*aCardiac : d+spneu, hear0 papi0a0ions

Diges0ive : Epigastric pain Muscuos6ee0a : nor*a 3-0re*i0+ : oede* pan0ar

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PHYSICA E!A"I#A$I%#

PHSICAL 3AMI)ATI)

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Nutrient Status

• Weight : 68 kg

• Height : 165 cm

• BMI : 68 = 5o!er"eight  #1$65% 1$ 65&

'atient Status

• (ge : 5years ol)

• Se% : Male

*ital sign

•+, : 16-.1-- mmHg

•H/ : 8-%. menit

•// : -% . menit

•+ : 06 o C

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 Thora-LungI#SPE&S

I

A#$E'I%' P%S$E'I%'

S0a0ic // : $' -@*in, H+perpig*en0a0ion9;, spider nevi 9;, a0ro> M.

Pec0orais 9;, He*i0hora6s DS,ICS )or*a

// : $' -@*in, Hiperpig*en0asi9;, spider nevi 9;, He*i0hora6s

DS, ICS )or*a

Dina*ic Up and do5n o7 he*i0ora6s DS ,

abdo*ino0hora6a brea0hing 9;,*usce re0rac0ion o7 brea0hing 9;,re0rac0ion ICS 9;

Up and do5n o7 he*i0ora6s

DS, abdo*ino0hora6abrea0hing 9;, *usce re0rac0iono7 brea0hing 9;, re0rac0ion ICS

9;

Papa0ion Papa0ion pain 9;, 0u*or 9;, Arcuscos0ae ange E"", enarge*ne0 o7

ICS 9;, S0e* 7re*i0us DS

Papa0ion pain 9;, 0u*or 9;,S0e* 7re*i0us DS

Percu0ion De-0ra : sonor De-0ra : sonor

Auscu0a0ion

 5hee2ing 9;, ronchi 9@; 

5hee2ing 9;, ronchi 9@;

In0erpre0a0ion : ronchi

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$H%'A!(C%'I#SPE&SIIc0us cordis be seen

PAPA$I%#Ic0us cordis is papabe a0 ICS FI, 1 c* *edia 7ro* inea *id cavicua

sinis0ra, 0hri 9;, pusus epigas0riu* 9;, pusus paras0erna 9;, s0erna

i70 9;PE'C)$I%#Du sound

Upper borderine

!ais0

Lo5er righ0borderine

Lo5er e70borderine

: ICS II inea s0ernais sinis0ra: ICS III inea paras0ernais sinis0ra: ICS F inea s0ernais de-0ra: ICS FI, 1 c* a0era 7ro* inea *id cavicua

sinis0ra

A)SC)$A$I%#

 Aor0a vave

Pu*ona vave

: S# G S$ s0andar0, addi0iona sound 9;, AIA$: S# G S$ s0andar0, addi0iona sound 9;, P#P$: S# G S$ s0andar0, addi0iona sound 9;, T#T$: S# G S$ s1 ao <

In0erpre0a0ion : cardio*ega+ G gaop *i0ra

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*domen

  Insection: Symetric, sycatric(-), striae(-), squama(-) enlargement of vena

(-), hyperpigmentasi (-), spider nevi (-), caput medussae (-)

  (uscultation :• Peristaltic (N)

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 Normal

PERCSS!"N P#$P#%!"N

shifting dullness (-), undulationtest(-)

&epar ' deaf (), liver span

detra *+ cm, liver span

sinistra cm

$ien ' troue space 

tympani

Suer2isial :

mass (-), adominal pain (-),costoverteral .noc. pain (-)

,eeer :

#dominal pain () epigastricregio/

hepar is not palpale,

lien is not palpale,

.idney is not palpale/

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E+tremityE,stremity Superior Inferior

Pitting oedem (-( .-.

Cold

e+tremities

(-( (-(

Physiological

'e/ect.-. .-.

I,teric (-( (-(

Impression oedem plantars

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oo5 Up$anggal $0 H' '' $

1"@E #("@4" #$" $$ 1(.1

#@#" #1"@4" #$" $& 1(,%

$@#" #1"@E" #$" $' 1(

1@#" #&"@4" 4" $" 1(,&

'@#" #'"@4" #"" $$ 1(,&

&@#" #&"@#"" #"" 1$ 1(

(@#" #E$@##& #"4 11 1(,&

%@#" #4"@E" #$& #E 1&,E

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'outin 1lood test3enis

emeriksaan

Hasil

& *0,1 g2dl (**,34 *5,5)

anemia

&t 10,56 (11-756)

$eu.osit 8,57 riu2u$ (1,8-**,0)

%romosit 3* riu2u$ (*50-770)

tromositopenia

reum 75 mg2dl (*0-50) a9otemia

Creatinin ,8 mg2dl (0,5-0,:)

%otal protein 3,01 g2dl (8,0-,0)

#lumin +,7 g2dl (1,7-7,)

hipoaluminia

;loulin 7,*: g2dl (*,5-5)S;"% 30 ! 0-50

#10.11.-14&

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'%#$2E# $H%'A!

  Jardio*egai9LF;

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I)T3/P/3TASI

  Ira*a : SI)US 

/eguari0as : /eguar  re6uensi:#&"":#(E1

  A-is : )AD  Kona 0ransisi : F'  =e. P : ",#$ de0i6

  In0erva P/ : ",$"de0i6

  /S : ",#$ de0i6  Seg*en ST : ST  =e. T : 0ida6 ada 

J3SA) : )sr

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US= Abdo*en

I 0 0 0i US=

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In0erpre0a0ion US=Abdo*en

  U6uran 6edua gina 6eci denganga*baran proses 6roni6 gina.

  Jis0a gina 6anan di poe a0as u6urandia*e0er se6i0ar #,$& c*.

  Nuid coec0ion *ini*a di resesusspenorenais

  hepar, ien dan pan6reas daa* ba0asnor*a.

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Da0a Abnor*ai0+

PhysicE+amination

34Cardiomegaly 5ith gallop6.7

84%edeme,+tremity94Hipertensi

Advance e-a*ina0ion

. Lab : E. Tro*bosi0openia

#".ane*ia

##.a2o0e*ia

#$.hipoabu*enia

#1.obesi0as ##'.3n2i*

0ransa*inase

#&. /on0gen0 0hora6s:

  6ardio*egai

#(.3C= :

)S/#%.3cho :

3 11O

#4.US=

=ia 6ronis

Anamnesis#.Dispneu$.Hear0papi0a0ions1.3pigas0ricpain'.Cough&.Sesa6 padasaa0 a60i>0as

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Probe* Lis0

  CH : #,$,',&,(,%,#&,#%  CJD : E,#",##,#4  Hiper0ensi  Hipoabu*inia   Tro*bosi0openia  besi0as

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CH n+ha ivAss :

• LFH 9L3T F3)T/IJ3L

HIP3/T/PI;• 3TIL=I : HIP3/T3)SI

IP 0+ :• B)P, Pro B)P

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Ip $+ :• Farma,ologi• in7us /L #"#& 0p*• In. urose*id $- #A

• P :•

Digo6sin ",$& *g $-#@$• Fasar0an #("*g $-#• Spironoa60on $&*g

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Ip"+ :

• Fi0a sign

IpE+ :

• Te abou0 his iness• Decrease hard ac0ivi0+• Dii0 o5 sa0

• Lo5 e-ercise 95a6ing, s5i**ing;• Consu*e drugs reguar+• /u0ine con0ro

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CJD

  Assessment :• Asidosis meta*olic

• %edem pulmo

• IP4 0+• 12A

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Farma,ology :• hemodialisisCaC%; ; +

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  IP. M- : reduc0ion o7 oede*, inpu0ou0pu0 bod+ Nuid

  IP. 3- :

• Die0 o5 5a0er 9# geas;• Die0 o5 pro0ein

• Bed res0 9is0iraha0 cu6up;

• Die0 o5 7os7a0 9susu, soda;

• Die0 o5 6aiu* 9pisang , s0ra5berr+,se*ang6a, *eon, anggur;

• Peneasan he*odiaisa 9$ 6ai se*inggu;

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Hiper0ensi =rade II

Assess*en0 : hiper0ensi *aigna

hiper0ensi benigna  IpD- :

• Fundus,opi

  IpT- :• )on Phar*acoog+ :

Bed res0

Die0 o5 sa0

• Phar*acoog+ :

inB4 Furosemid @ +A

alsartan 3=mg +

IpM- :  TTF

Ip3- :

• Die0 o5 sa0, be0 res0

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HIP%A1)"I#E"IAAsses0*en0 : IPD- : IPT- :

)on 7ar*a6oogis : Bed res0.ar*a6oogis : In7us abu*in

• abu*in corec0ion

• 9) abu*in in pa0ien0; - !eigh0 - ",4 : $&

• 91,& #,('; - (4 6g - ",4

• #"# gr@dL

IPM- : ede* e6s0re*i0asIP3- :  Minu* oba0 dan 6on0ro 0era0ur  Ma6an *a6anan +ang *engandung abu*in

9pu0ih 0eur, 6acang6acangan,i6an

gabus,susu;

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 T/MBSITP3)IA  Ass :

diagnosa e0ioogi :• 0ro*bosi0openia 6arena oba0

• ITP

Ip d- : hi0. Darah eng6ap , pe*eri6saan su*su* 0uang

Ip 0- :ar*a6oogi :  0ran7usi 0ro*bosi0 i6a 1"rb 

Prednison #*g@6g #-#

)on 7ar*a6oogi :• penghen0ian pe*a6aian oba0 +ang diduga *en+ebab6an

0ro*bosi0openia

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  Ip *- : 6adar 0ro*bosi0, 0anda 0andaperdarahan

  Ip e- :  Is0iraha0 cu6up   Tida6 *inu* a6oho   Tida6 *ea6u6an oahraga +ang *eiba06an 6e6erasan

>si6

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besi0as#ss ' */ oesitas sentral

  +/ oesitas perifer 

 

!p arma.ology ' modifi.asi gaya hidup (a.tivitas fisi., pola ma.an

(diet rendah .alori, dll)

  >arma.ologi ' -

  !p= ' ?erat adan, %e.anan

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Ip3- :

%urun.an ?erat adan

#tur pola ma.an (Sesuai @eutuhan @alori)

"lahraga Ringan setiap hari (semampunya)

=inum "at %eratur 

Rutin Ce. ?erat ?adan, %e.anan

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$E'I"A &ASIH