cc 10 februari 2016.pptx

8/19/2019 CC 10 februari 2016.pptx

1/41

LAPORAN JAGA COASS OBSGYN

Rabu, 10 Februari 2016


2/41

Daftar Pasien Masuk


3/41

No Identitas Diagnosis Terapi

1 Ny SP3A031 tahun

Kistoma ovarii suspmalinan!y " an#mia $%&3' "hi(ron#)rosis sinistra r **

•

+on(o, -ansal• Pro ,ist#,tomi " ./

• O 3 lpm nasal ,anul

• sul !#, CA 12

• Punsi As!it#s

Ny PPA145 tahun

Ca S#rvi6 *** B " *nsu) r#nal"an#mia $%&7' " l#u,ositosis "hipoal-umin $&0'

•

+on(o, -ansal• *n8 !#)tria6on# 1

amp94 8am• Konsul int#rna• :rans)usi s9( ;- 10• :rans)usi al-umin•

Pro ,#mot#rapi

Rabu, 10-02-2016 Pukul 14.00-07.00


4/41

No Identitas Diagnosis Terapi

3 Ny LP3A02< tahun

Ca ovarii post *CSS "as!it#s

Pro stain C#, la-

Ront#n thora6

SG a-(om#n

4 Ny *RKSGP1A032 tahunK 3% m

Out!om#=La,i>la,i& 3300ram& AS 2>7>5?i(apat,an,#lainanhy(ro!#phalus" C:@

Kala ** )#tal (istr#ss pa(as#,un(iravi(a hamil at#rm(#nan hi(ros#phalus "(an(y al,#r mal)ormation" C:@

Lan8ut p#rsalinanp#rvainam?ip#rinan (#nan @Siap,an r#susitasin#onat#s

Rabu, 10-02-2016 Pukul 14.00-07.00


5/41

Laporan Kasus


6/41

A. Identitas pasien Nama = Ny *RKS

mur = 37 tahun

Alamat = Kutai :imur& Kalimantan :imur

P#,#r8aan = *-u Rumah :ana

:anal +asu, = 10 .#-ruari 017

:l P#m#ri,saan = 10 .#-ruari 017

No R+ = 013%70

I. ANAMNESIS

B. Keluhan utamaG#ra,an 8anin -#r,uran


7/41

. !i"a#at pen#akit sekarang

S#oran GP1A0& 37 tahun& K 3%"1 minu

(atan ru8u,an RS? Sra#n (#nan ,#t#ranan

GP1A0 hamil 3% minu& inpartu ,ala 1 )as#

a,ti) " hi(ro!#palus

Pasi#n m#rasa hamil % -ulan& ,#n!#n>,#n!#n

t#ratur su(ah (irasa,an& #ra,an 8anin masih

(irasa,an& Air ,aah su(ah (irasa,an ,#luar

s#8a, 1 8am S+RS& l#n(ir (arah $"'


8/41

D. !i"a#at pen#akit dahulu

Riayat ?+ = (isan,al Riayat hip#rt#nsi = (isan,al

Riayat sa,it asma = (isan,al

Riayat sa,it 8antun = (isan,al Riayat al#ri = (isan,al


9/41

E. !i"a#at haid• +#nar!h# = 1 tahun

• Lama hai( = 5>< hari

• Si,lus hai( = < hari

$. !i"a#at perka"inan• +#ni,ah 1 ,ali

• Lama = 1 tahun

%. !i"a#at KB

KB = $>'


10/41

Status #n#ralis

K#a(aan mum = tampa, sa,it rinan&

iDi ,#san !u,up

:an(a vital

:#, ?arah = 1309


11/41

Kon8untiva pu!at $>9>'

S,l#ra *,t#ri, $>9>'

A-(om#n =Sup#l& N: $>'& t#ra-a 8anin

tunal *& m#man8an& pr#s,#p&

pu,a& ,#pala masu, panul E93

-aian& his $"' 46910F940& (88 $"'

10069m#nit ir#ul#r

Cor9pulmo

(-n

G#nital=

:= v9u t#nan& (in(in vaina (-n&

portio luna,& H l#n,ap& #)) > I&

pr#s,#p& ,#pala ; ***" & KK $>' (an

p#nun8u, KK (i 8am 1& AK $"'8#rnih ti(a, -#r-au& S:L? $"'


12/41

*** LABORA:OR*+ ?AN P@+@R*KSAAN P@NNJANG

La-oratorium ?arah $10 .#-ruari 017'• ;- = &'.( g)dL• ;!t = 33 *• A@ = +.',-&')/L

• AL = &(.&-&'0

)/L• A: = 1


13/41

Kesimpulan

S#oran GP1A0 37 tahun K 3%"3 m (#nan riayat

)#rtilitas o-st#tri& ,#n!#n>,#n!#n t#ratur su(ah(irasa,an& air ,aah su(ah (irasa,an ,#luar s#8a, 1 8am

S+RS& l#n(ir (arah $"'

Pa(a p#m#ri,saan )isi, a-(om#n& (i(apat,an sup#l& ny#ri

t#,an $>'& t#ra-a 8anin tunal *& m#man8an& pr#s,#p&

pu,a& ,#pala masu, panul E93& ;*S $"' 46910F940& (88$"' 10069m#nit ir#ul#r

Pa(a p#m#ri,saan #nital& := v9u t#nan& (in(in vaina

(-n& portio luna,& H l#n,ap& #)) >I& pr#s,#p& ,#pala ;***" &

KK $>' (an p#nun8u, KK (i 8am 1& AK $"' 8#rnih ti(a,

-#r-au& S:L? $"'


14/41

?ianosis

Kala ** )#tal (istr#ss pa(a s#,un(iravi(a ;at#rm& (#nan ;i(ro!#phalus " ?an(y al,#r+al)ormation& C:@

Lanjut persalinan pervaginam >> peringandengan VE

Siapkan resusitasi neonatus

TE!API


15/41

Out!om#

0420

?#nan @ lahir -ayi la,i>la,i BB 3300

ram& AS 29795

?i(apat,an ,#lainan hi(ro!#phalus (an

C:@

0422

Plas#nta lahir l#n,ap& -#ntu, s#p#rti

!a,ram u,uran 1


16/41

:*NJAAN PS:AKA


17/41

;i(ro!#phalus


18/41

Definisi

;i(ros#)alus a(alah ,#lainan patolois ota,yan m#na,i-at,an -#rtam-ahnya !airans#r#-rospinal (#nan atau p#rnah (#nant#,anan intra,ranial yan m#nini&s#hina t#r(apat p#l#-aran v#ntri,#l$?arsono& 002=0%' P#l#-aran v#ntri,ul#r

ini a,i-at ,#ti(a,s#im-anan antarapro(u,si (an a-sor-si !airan s#r#-rospinal


19/41

Etiologi

;i(ros#)alus t#r8a(i -ila t#r(apat

p#nyum-atan aliran !airan s#r#-rospinal

$CSS' pa(a salah satu t#mpat antarat#mpat p#m-#ntu,an CSS (alam sist#m

v#ntri,#l (an t#mpat a-sor-si (alam

ruan su-ara,noi( A,i-at p#nyum-atan&

t#r8a(i (ilatasi ruanan CSS (iatasnya

$Allan ; Ropp#r& 002'


20/41

Klasifikasi

1 Gam-aran ,linis& (i,#nal hi(ros#)alusmani)#s $ov#rt hy(ro!#phalus' (anhi(ros#)alus t#rs#m-unyi $o!!ult

hy(ro!#phalus' a,tu p#m-#ntu,an& (i,#nal hi(ros#)alus

,on#nital (an hi(ros#)alus a,uisita

3 Pros#s t#r-#ntu,nya& (i,#nal hi(ros#)alus

a,ut (an hi(ros#)alus ,roni, 4 Sir,ulasi CSS& (i,#nal hi(ros#)alus

,omuni,ans (an hi(ros#)alus non ,omuni,ans


21/41

Manifestasi Klinis

1' P#ru-ahan tan(a>tan(a vital $p#nurunan )r#,u#nsi p#rna)asan&

p#nin,atan :?'' +untah

3' P#nin,atan lin,ar ,#pala

4' L#tari

2' A,tivitas ,#8an

7' Pa(a -ayi

$1' P#m-#saran ,#pala s#!ara pror#si)

$' Baian )rontal t#n,ora, m#non8ol

$3' .ontan#ta t#an (an m#non8ol $,hususnya yan ti(a, -#r(#nyut'

$4' ?ist#nsi v#na sup#r)isial ,ulit ,#pala

$2' :ransilominasi m#lalui t#n,ora, m#nin,at s#!ara sim#tris

$7' +ata turun ,# -aah $sun s#t #y#s'5' Pa(a ana, yan l#-ih -#sar

$1' Sa,it ,#pala (i (ahi& mual& (an muntah

$' Anor#,sia

$3' Atar#,sia

$4' K#,a,uan #,str#mitas -aah

$2' K#mrosotan pr#stasi s#,olah atau ,#mampuan ,oniti) ana,


22/41

Pemeriksaan diagnostik

Lin,ar ,#pala

C:>s!an = i(#nti)i,asi t#mpat o-stru,si

+R* $+an#ti, R#sonans# *main' P#m-#saran v#ntri,#l Lum-al punsi


23/41

Terapi

Pa(a (asarnya a(a tia prinsip (alam

p#no-atan hi(ros#)alus& yaitu =

a' +#nurani pro(u,si CSS

-' +#mp#naruhi hu-unan antara

t#mpat pro(u,si CSS (#nan t#mpat

a-sor-si!' P#n#luaran li,uor $CSS' ,#(alam

oran #,stra,ranial $?arsono& 002'


24/41

P#nananan hi(ros#)alus

8ua (apat (i-ai m#n8a(i =1 P#nananan S#m#ntara

P#nananan Alt#rnati) $S#lain Shuntin'

3 Op#rasi P#masanan PintasF $Shuntin'


25/41

?an(y al,#r

syn(rom#


26/41

?an(y al,#r syn(rom# a(alah suatu sin(rom

$,umpulan #8ala' yan t#r8a(i pa(a s#oran ana,

a,i-at ti(a, t#r-#ntu,nya pintu ,#luar !airan ota,

(ari (alam ,#pala ?alam -ahasa m#(is& pintu ,#luar ini(is#-ut (#nan suatu lu-an ,husus yaitu yan

(inama,an (#nan .oram#n Lus!h,a (an +a#n(i#


27/41

@tioloi

• ?alam ,#-anya,an ,asus& penyebab sindrom Dandy Walkertidak diketahui.i(iopati,

• S#oran i-u (#nan (ia-#t#s l#-ih mun,in (i-an(in,ani-u yan s#hat untu, m#mili,i ana, (#nan sin(rom ?an(y>al,#r

(ia-#t#s

• Paparan o-at anti 8#raat $anti>8#raat' (is#-utisotr#tinoin s#lama tia -ulan p#rtama pa(a saat -ayi-#r,#m-an (alam tu-uh in(u,Paparan t#rs#-ut (apatm#nanu p#r,#m-anan #m-riolois

isotr#tinoin


28/41

• ?an(y > al,#r palin s#rin t#r8a(i pa(aoran (#nan trisomi 1 al,#r t#lah (ilapor,an

pa(a 8anin atau -ayi -aru lahir (#nantriploi(y & ,on(isi )atal (i mana in(ivi(um#mili,i satu s#t l#n,ap #,stra ,romosom(alam s#tiap s#l

#n#ti,

• P#ny#-a- (isaran,an lainnya a(alah paparan

ru-#lla& !ytom#alovirus & to,soplasmosis&ar)arin $Couma(in'& (an al,ohol

P#ny#-a-lain


29/41

Pato)isioloi


30/41

?alam t#orinya& !airan ota, manusia t#rs#-ut -#ra(a (i

(alam rona !airan ota, yan s#tiap hari (ipro(u,si (i

(alam ,#pala (an s#tiap hari (i-uan ,#tu-uh ,ita

.oram#n Lus!ha +a#n(i# m#rupa,an pintu ,#luar!airan ota,& apa-ila )oram#n t#rs#-ut t#r8a(i o-stru,si

ma,a a,an t#r8a(i anuan aliran !airan ota, yan

m#ny#-a-,an p#numpu,an !airan ota, yan (is#-ut

hi(ros#)alus


31/41

;al ini a,an -#r(ampa, t#r8a(inya p#m-#saran rona

!airan ota, yan a,an m#n#,an 8arinan ota, (i

s#,itarnya (an 8ua m#na,i-at,an p#m-#saran pa(a

rona !airan ota, (i s#,itar ota, ,#!il $#ntri,#l *'&(is#rtai pula (#nan t#r-#ntu,nya ,ista -#sar (i (a#rah

ota, ,#!il $!#r#-#llum'& s#hina s#-aian ota, ,#!il

$-aian t#nah' ti(a, tum-uh& ,#mun,inan ,ar#na

t#rham-at ol#h ,ista -#risi !airan ota, yan m#numpu,

t#rs#-ut


32/41

G#8ala ,linis

ANAMNESIS

P#n(#rita ,#lainan ini pa(a umumnya (atan (#nan

,#lainan ham-atan p#rtum-uhan $(#v#lopm#ntal (#lay'&

p#m-#saran lin,ar ,#pala (an hi(ros#)alus& yan tampa,pa(a %0I p#n(#rita

:an(a>tan(a p#nin,atan t#,anan intra!ranial t#rlihat

pa(a ana, usia l#-ih -#sar (an oran (#asa s#p#rti

muntah& r##l (an ,#8an & namun 8aran t#rlihat pa(a

-ayi

P#rlu (itanya,an 8ua apa,ah a(anya )a!tor pr#(isposisi&

yaitu paparan in)#,si ru-#lla (an to,soplasmosis& al!ohol&

ar)arin& s#rta isor#tinoin pa(a tris#m#st#r p#rtama

,#hamilan


33/41

P#m#ri,saan

)isi,

P#m-#saran lin,aran ,#pala

K#lainan pa(a tulan ,#pala&

yaitu p#non8olan pa(a o!!iput

,ar#na p#m-#saran pa(a )ossapost#rior

?is)unsi C#r#-#llar

$ ,#ti(a,sta-ilan ,#ti,a

-#r#ra, atau -#r8alan&

,urannya ,oor(inasi otot

atau mata -#r#ra,>#ra,ti(a, normal'Ganuan

,#s#im-anan& spastisitas&

(an anuan #ra,an halus

8ua s#rin t#r8a(i

P#r,#m-anan int#l#,tual

yan r#n(ah -#rhu-unan(#nan annuan

p#n(#naran& p#nlihatan&

s#rta ,#lainan sist#mi, (an

syst#m sara)

P#m#ri,saan p#nun8an


34/41

P#m#ri,saan p#nun8an


35/41

Pemeriksaan penun1ang ter2aik untuk diagnosis

Dand# 3alker S#ndrome adalah /S% dan M!I4 (imana

(ianosis aal (apat (it#a,,an (#nan SG pr# (an

post natal yan (apat (ila,u,,an (#nan mu(ah (anti(a, p#rlu m#nuna,an s#(ativ#& s#lan8utnya -isa

(i,on)irmasi (#nan +R*


36/41

?ianosis

?an(y al,#r Syn(rom# (i(ianosis (#nan sinar> (an

C: $!omput#riD#( tomoraphy' S!an ota,


37/41

P#natala,sanaan

Pera"atan medis5

:#rapi )isi, s#rin (iuna,an untu, m#m-antu pasi#n

m#nin,at,an )unsi motori, a-normal m#r#,a Namun&-anya, oran masih a,an t#rus m#nalami ,#sulitan

-#r8alan (an m#mili,i anuan ,#s#im-anan

P#no-atan lain a(alah (#nan m#m-#ri,an o-at untu,

m#nurani ,#8an K#8an #ra,an otot ta, sa(ar (an 9atau p#nurunan ,#sa(aran lin,unan ,ar#na

ov#r#6!it#m#nt s#l>s#l sara) (i ota,


38/41

P#raatanB#(ah=

Shunt

P#no-atan -iasanya

t#r(iri (ari shunt untu,m#natasi

hi(ros#)alus Ahli -#(ah

sara) (apat m#m-uat shunt

,ista $!ystop#riton#al'&

v#ntri,#l

$v#ntri!ulop#riton#al'&atau ,#(uanya


39/41

62at5

:i(a, a(a o-at yan -isa m#no-ati ,#lainan -aaan ini

m#s,ipun a(a o-at yan (apat m#no-ati masalah yanm#n(asari

Diet5

:i(a, a(a ?i#t ,husus untu, ?S ?i#t (ila,u,an

-#r(asar,an pa(a masalah>masalah t#r,ait ?S


40/41

Komplikasi dan Prognosis

Kompli,asi= ;y(ro!#phalus & P#nin,atan :*K& Poly(a!tyly &

Sin(a,tili& Papillo#(#ma

P!6%N6SIS

Ana,>ana, (#nan sin(rom ?an(y>al,#r mun,in ti(a,

p#rnah m#mili,i p#r,#m-anan int#l#,tual yan

normal& -ah,an ,#ti,a hi(ros#)alus yan (io-ati s#!ara(ini Pronosis t#rantun pa(a tin,at ,#parahan (ari

sin(rom (an mal)ormasi t#r,ait K#ha(iran -#-#rapa

!a!at -aaan (apat m#mp#rp#n(#, umur


41/41

:#rima Kasih

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