group 03 case 1a.ppt

8/15/2019 GROUP 03 CASE 1A.ppt

1/99

“ GOSH… Mrs.DOUBTFIRE… YOU LOOK

PALE “CASE 1A

BY : GROUP 3 TUTOR : DR. KUMALA DEWIBLOCK : GASTROINTESTINAL

FACULTY OF MEDICINE TARUMANAGARA UNIVERSITYAUGUST !"#$ %%&


2/99

NIM NAME

'%(%)%%(1 ERIK ADITYA

'%(%)%%(* RIODIAN S

'%(%)%%* FORSALINA T

'%(%)%%*3 ALINE C LEADER

'%(%)%%** MAILAN +'%(%)%1! SUSANTI L SCRIBER

'%(%)%1& ANDRUW T

'%(%)%13' GRISELDA T SECRETARY

'%(%)%1'! HOSANA T

'%(%)%1(3 DANIEL ,

'%(%)%1*3 EMELIA W

'%(%)%1*' ANNASTA P


3/99

“ GOSH… Mrs. D-/"0r… Y-L--2 P4 “

• W#54 6- 7r 7"8#59 “Hrr6 P-""r 9; T# G-/4" -< F5r= 59 TV ""# >r986 ;?r">9" 6- 7-r2;


4/99

ANATOM Y OF GIT


5/99


6/99


7/99


8/99


9/99


10/99


11/99


12/99

• UPPER GASTROINTESTINAL TRACT:

Es-?#sGs"rD-;9>Pr-5>4 +9>Tr5" 45>9"

• LOWER GASTROINTESTINAL TRACT:

Tr5" 45>9"D5s"4 +9>I4>C-4-9A9s


13/99

HYPOACTIVE BOWELSOUNDS

• rs4" ;8rs; ?r5s"4s5s$ 7#58#$59 "r9$ 89 rs4" ;4-?59/-74 -/s"r8"5-9 9; "# s -< 8r"59

;rs$ /;->594 srr6$ 9; r;5"5-9"#r?6.

• T# -/s"r8"5-9: – >8#9584 s #r95$ ">-r

–s84r s 9 >/-45s> -r "#r->/-s5s

– 9r-958 s >8#9584$ 5s8#>58$ -r"-58 5>?5r>9" -< /-74 599r"5-9


14/99

SYNDROME OF DYSPEPSIA

• ?rs5s"9" -r r8rr9" ??r/;->594 ?59 -r ;5s8->


15/99

SYNDROME OF DYSPEPSIA

• E?5;>5-4-6: E8# 6r 1%% -< US?-?4"5-9 s2s >;584 ""9"5-9.NUD 3 ??"58 48r ;5ss.

• E"5-4-6 J P"#-9s5s:I>/498 -< "# r"59


16/99

AGGRAVATING FACTORS OFSYNDROME DYSPEPSIA:

• Gs"r58 85;• P?s59• H458-/8"r ?64-r5 59-"-r 8"55"6: ((% ?"59"s #5/5" ?-s"?r9;54

9"r4 #6?->-"545"6 -r ;46; s"r58 >?"659• Ps68#-4-584 -259"-/88-$ 48-#-4• Drs: 9-9s"r-5;4 9"559>>"-r6 ;rs9s5;$

"r;5"5-94 ?59 2544r ;rs$ s"r-5;s$9"5/5-"58sr6"#r->6859$ >?5854459$ 5r-9$ ?-"ss5>$;5-59$ "#-?#64459.

• M"/-458 ;5sss: ;5/"s >445"s$ #6?-"#-r-5;5s>• H6?-?-"ss>5.• Fr r;584s


17/99

DEFENSIVE FACTORS OFSYNDROME DYSPEPSIA:

• Pr-s"49;59

• M8s

• M8-s4 /4--; -7

• Sr


18/99

CLINICAL FEATURES INSYNDROME DYSPEPSIA

• N-9 U48r D5ss: – U48r 452: ;->599" ?5s"r58 ?59$ r45;

/6 9"85;s -r -"545"6 452: ?5s"r58 ;5s8->s ;-s 9-" 0" "# -"#r8"-r5s

– R 452: #r"/r9 9; rr5""5-9

• U48r: "# s> 75"# NUD


19/99

PHYSICAL EAMINATION INSYNDROME DYSPEPSIA

• 9-" s?8508

• ?5s"r58 "9;r9ss s-> "5>s

•

/;->594 >ss 5< ;98; s"r588r859->


20/99

COMMON CAUSES OF COMMONGI ABDOMINAL PAIN

• A??9;585"5s• G44s"-9 ;5ss• P98r"5"5s• )iverticulitis•

*lcer disease• +sophagitis• ( obstruction• (nammatory .owel )isease /(.)0• F98"5-94 /-74 ;5s-r;r

• 1ascular disease• G698-4-58 8ss• r94 s"-9


21/99

VOMITING


22/99

COMMON CAUSES OF COMMONGI NAUSEA AND VOMITING

• M;58"5-9s• ( obstruction• M-"-r ;5s-r;rs

• F98"5-94 /-74 ;5s-r;r• E9"r58 59 ;5ss


23/99

H>">s5s

• H>">s5s >9s ->5"59 -rrr5""5-9 -<


24/99


25/99

M49

• P94r9 9254"$ /r/ /s2$;9 492".

• T# 8-4-rs ;?9; -9 4-9 /"79s"r58 85; Wr9 >49 "r9"9

;r5 4>96 #/99 9"r ;r#;99 s> 4>/9$ /sr 285496?r;r#9$ 28?"9 ?r;r#9$ 4-2s5?r;r#9 ;9 ?rr29 ss.


26/99

PATHOLOGY OF MELENA

• P; >49$ ;4> ?r4996 >445 ss$ ;r# >9;5/r7r9 >r# 4? /#29 #5">. Pr/#9 7r9 595;5s//29 -4# HCL 4>/9$ ??s59$ ;9 7r9 #5"> 595;5; 2r9 ;96 ?5>9 ?-r0r59. K;92;9 ?;?r;r#9 s4r9 8r9 /59 /7# ;r5 ss #4s "2-4-9 s9;9$ 984 ;r5 ;-;9> ;9 9>29 "r"#9 ?; s4r9 8r9 s25"r *! > 9"2>r/# 7r9 9;5 #5">. P459 s;525"?r;r#9 s/962 (%1%% 88 /r ;5>?5 2;9>49. Fss ""? /r7r9 #5"> s?r"5 "r s4> '!)

> s"4# ?r;r#9 /r#9"5. I95 /29 /rr"5 24r96/965 "r;?" ?; )1% #r5 s"4# ?5s-; ?r;r#9 "94.


27/99

1(%)('+ 1ascular/10

(nammatory/(0

%eoplasm/%0

)egenerativeand )e4ciency/)0

(ntoication/(0

Os-?#s esophageal varices

ROs-?#"5"5s

arcinomaoesophagus 9;49

L6 9; -"#r5rr5"9"s

*lcer

A-r"589r6s>

Tr6?9-s->5s5s 8r5

F-r59 /-;6

S"->8# Cr;58

r58s

astritis arcinoma A"r-?#58

s"r5"5s

A48-#-458

s"r5"5s$s?5r59$ 9;-"#r ;rs..$ rs958

R?"r;9r6s>

Gs"r58 48r

D-;9> *lcerP98rs A8"

?98r"5"5s#>-rr#58

B4--; L25>5 A?4s"58 9>5 Wr59 K;085986

H?r59

O"#r ;rs


28/99

1(%)('+

ongenital/0

'utoimmune'llergic /'0

rauma/0

+ndocrine/+0

Os-?#s

H5"4 #r95 S84r-;r> F-r59 /-;6

esophagitis Ns-s"r58"/

7allory-8eisssyndrome

S"->8# Hr;5"r6"4958"s5s

Pr

D-;9> R5-94 545"5s Pr

P98rs

B4--; H>-?#5459; -"#r C-449;5ss 9;


29/99

e9ala +soagus :ambung )uodenum :ower (

N6r5 •A2#4s5•R2s

•Gs"r58 U48r•C Gs"r58

•D-;94 U48r •IBD•D5r"584

M4

M9"#

•A2#4s5•R2s

•C Es-s5s

•+sophagitis•;uptur1arices+soageal•

7allory-weissear•1ascular:esions•%eoplasm

•astric *lcer•astritis•1aricesastric

•)uodenal *lcer•1arices)uodenal

M49$Fr92 B4--;$O884"B4--;

•R?"r Vr58sEs-


30/99


31/99

ESOFAGITIS

• Es-?#5"5s ;4# ?r;99 ?;s-99229;96 ?9;r#9 >9;;2

– ( ?9;r5" >94# ;5s


32/99


33/99

CLASSIFICATION OFESOPHAGITIS

• K4s502s5 /r;sr29 "5-4-5 :

– s-?5"5s ??"52 r2s

– esopagitis korosi

– s-?5"5s 59


34/99

ESOPAGITIS KOROSIF

• Pr;99 ;5 s-95>/429 2rs29?; s4r9 69 ;544596


35/99

ETIOLOGI J PATOFISIOLOGI

• ,"" 25>5 /r? s> 2" J /s 2" >96//29 2>"59 s4 ?; ?r>29 69;544596

• Krs29 2r9 /s 2" s4 s4 >"5 ;9>985r

• Krs29 2r9 s> 2" 2>"59 s4 69>9>?4.

• P; 2rs29 69 ;5s//29 -4# s> 2"$>2 2rs29 29 ;54>5 4/5# /r" ?;4>/9 ;52r929 ;96 s> 4>/9 69"r" >>?r/r" 2rs29 s4s4 ?; >2-s$""?5 ?; /s 2" 69 "r;5 ;4# s/45296$2rs29 4/5# /r" ?; s-?#s.

• ," -r952 s?r"5 45s-4 J 2r/-4 >95>/429;> ;5 >2-s " s/>2-s


36/99


37/99

KARSINOMA ESOFAGUS

• S9" 2->?42s ;9 >45299


38/99

MACAMMACAM KARSINOMAESOFAGUS

• Krs59-> ?5"4 /r4?5s ?9

• A;9-2rs59->


39/99

TANDA OB+EKTIF

• Rr5"s5 >9-9-4 ?; 2;9 4/5# 49".• Sr ?r /5s "r;5 ?/54 ?5" sr >94>5

?r45s5s.• B"2 2r-952 "5>/44 /54 "r;5 0s"4 s--r s>?" >9"# ;r# ;?" "r;5.• S59;r-> H-r9r• Pr45s5s ;5• K->?rs5 ?42ss /r2545s• S59;r-> 9 8 s?r5-r• E


40/99

GE+ALA

• S";5> ;595 /4> ; 24#9$ /5s9624#9 "> /5s96 ;5s299 "rs92" ?; "9-r-29;9 ;r# r"r-s"r94 ;524#49 #>?5r&% ?s59. O;59-r?2924#9 s/2"5< ?9;r5".

• P9;r5" 29 s45" >949 >299?;" ;9 85r. L/5# 49" 29>95>/429 rr5"s5 ?; s">29 " >59>.


41/99

VARISES ESOFAGUS

• Tr;5 s/5 25/" #5?r"9s5?-r"4 "r/9"2 2-4"r4$ ;59"r96 9 ;5 s-9;5 /sr$ s#59 "5>/4r5ss s-


42/99

M44-r6W5ss s69;r->

• S/4> "5>/4 #>">s5s ;5;#45>9"#>9"# #/" 69 ?; 2#5r96/r "5>/4 ?r;r#9$ >5s496 ?;?>59> 42-#-4 " ?; #>54 >;.

• B5s96 ;5s//29 -4# 2r9 "r44sr59 >9"#>9"# #/" ;9 "rs>9rs.

•

B54 ?9;r5" >94>5 ;5s92599 ;5s//29 -4# 2rs59->s-


43/99

GASTRIC VARICES

• Gs"r58 r58s r >-r#>-;69>58


44/99

GASTRITIS


45/99

C#r-958 Gs"r5"5s

A"r-?#58 Gs"r5"5s Er-s5 Gs"r5"5s

Vr545

Gs"r5"5s


46/99


47/99

GASTRITIS

• Gs"r5"5s 5s 9 59>>"5-9$5rr5""5-9$ -r r-s5-9 -< "# 45959 -<"# s"->8# s"r58 >8-s. I" 89

-88r s;;946 8" -r r;4468#r-958.


48/99

RISK FACTOR OF GASTRITIS

• H. ?64-r5 59


49/99

ETIOLOGY OF GASTRITIS

• B8"r54 59>9 s"r5"5s

• O"#r ;5sss 9; 8-9;5"5-9s


50/99


51/99

SYMPTOMS OF GASTRITIS

• Ns -r r8rr9" ?s" s"->8#

• A/;->594 /4-"59

• A/;->594 ?59

•

V->5"59• I9;5s"5-9

• Br959 -r 9759 8#/"79 >4s -r " 95#"

• V->5"59 /4--; -r 8- r-9;452>"r54

• B482$ "rr6 s"--4s


52/99

ULKUS PEPTIK

• S" ;r# 2s2-r5s5 >2-s4>/9 " ss 69 "r">;5s//29 2r ?98r99 "#

4>/9 " s2rs5 ss #4s/59 "s

EPIDEMIOLOGI ULKUS PEPTIK


53/99

EPIDEMIOLOGI ULKUS PEPTIKDI AMERIKA SERIKAT

• ' " ?s59 /r J 2>/#"r29 42s ??"52 ?r "#9

• 1 ?r5 J 1% 795"

• 1(.%%% 2>"59 ?r "#9 "r;525/" 42s ??"52 69"r2->?452s5

ETIOLOGI J FAKTOR RISIKO


54/99

ETIOLOGI J FAKTOR RISIKOULKUS PEPTIK

• K"5;2s5>/99 9"r 28?"9 s2rs5"# 4>/9 J ;r" 69 ;5/r529 s7r>2-s s"r-;-;94 J 9"r45ss5 s>4>/9 -4# "# ;-;9>

•

K9;99 s> ;9 ??"52 Q• Ir5"s5• S?45 ;r# 69 /r2• S2rs5 >2s 69 /r4• I9


55/99

PATOFISIOLOGI ULKUSPEPTIK

• H ?64-r5 ?9"rs5 2>>?9 0s52 "4?s29 95>95> ?98r99 /2"r5469 >985r29 s7r s7r >2-s 4>/9 "# s> 2" ?98r99

?9"rs5 r599 ?5"45> J 8r9;59;59 GI 42s ??"52>

• Mr-2-2 ?Q r9s99 sr< ?;249r ?962rs- ;5 4>/9

• A42-#-4 >rs2 s7r >2-s

• As?5r59 J OAINS >rs2 s7r >2-s


56/99

GE+ALA ULKUS PEPTIK

• S25" ?r"

• K->?452s5 1% ?s59 ;99 OAINS69 59;2s5 ?9625" >2-s :

P9;r#9$ ?r

• K"5;296>99 /r#/99 ;99

2-9;5s5 >299$ 9s$ J BB• D5s??s5

CLASSIFICATION OF PEPTIC


57/99

CLASSIFICATION OF PEPTICULCER

+&=#'*& '&+; )*)+%*7 >+>*%*7

LETAK D5 " 4 # A 4 " D5 ;5 D5 " 4 ; 5


58/99

LETAK D5s"4 s-?#s A94s$ 9"r>$?r?54-rs

D59;599"r5-r ;9?-s"r5-r ;r5/4/s ;-;95

Prs ;s89;9

;-;95 ?r-2s5>4 ;r5??54 "r55

D5s"4 ;r59s"->-s ;5;59;59 9"r5-r

9>

NYERI B59 /7# s"r9>4 #"5 >9/r5>

s"r95 ;9 59"rs2?4r?99

Pr" 25r5 "s ?5s"r5>

?99 25r5A;96 96r5

"29 ;5?5s"r5>

Pr" 299"s ?r"

25r5 ;9?599 "s

N6r5 "29 ;5?r" 299"s ;2">/5452s

D5 ?r"$ /5925r5 >/5452s 2 ?599 25r5

N6r5 "29 ;5?r"$ s/4#25r5 >/5452s

RITME

NYERI

S" >29 >59>M>/9229 /;9

>29 96r5

96>9

T9# >4>

M29

96>9 96r5

SIFATNYERI

?9s ;5 ;; ;9 4#"5>4>9"#

Ms> ;5 >4" P;5# ;9?9s ;5 ?r"299 "s

P;5# ;9 ?9s;5 ?r" /5925r5 >/5452sM4M9"#

Ms> ;5 >4"


59/99

CA GASTRIC


60/99

F2"-r rs52-

• F2"-r rs52- 292r s"r 9"r 459#452-/2"r ?54-r5$ ;5" "595 95"r" 95"r-s>59s/5 ?97"$ >299 6 ;5s5929 ;9;5s?$ ?r-2-2$"r-0 4>/9.

•

D5 s>?59 5" ; ?9 – U>r$ 2/9629 292r 4>/9 ?; >r (%

)% "#9 ;9 r9 ;5 /7# '% "#9. – A42-#-4 – O?rs5 4>/9 s/4>96 – P-45? 4>/9 – S59;r-> 292r 5454


61/99

KLASIFIKASI TUMOR +INAK

• T>-r 592 ?5"4

• T>-r 592 9-9 ?5"4


62/99

TUMOR +INAK EPITEL

• A;9->

• A;9-> #5?r?4s"52 : ?-45?-5;s5r2>s2r5?$ ;5 #"r-"r-?52 : ">-r?92rs /r9$ /r959->


63/99

TUMOR +INAK NON EPITEL

• T>-r 9r-952

• L5->5->

• F5/r->

• L5?->


64/99

KLASIFIKASI TUMOR GANAS• Er46 s"r58 898r.

– T5? 1 ?r-"r;; "6?. T>-r 9s 6 >959s5 #96"r/"s ?; >2-s ;9 s/>2-s 6 /r/9"2?-45?-5;. B9"296 5r4r$ ?r>29 "5;2 r"$?r;r#9 ;99 "9? 4srs5.

– T5? s?r0854 "6? ;?" ;5/5 3 s/"5? :

. E4"; "6? : ">?2 s;525" 4s5 >2-s 4>/9$ #>?5rs?r"5 "5? 1$ ">?2 s?r"5 4s5 sr" ;9 4/5# >4s ;9>4/r.

/. F4" "6? : "5;2 "r45#" 4s5 ;?rs5 ?; >2-s ;9 #96"r45#" ?r/#9 7r9 >2-s

8. 8. D?rss; "6? : ;5;?"29 ?r>29 6 5r4r ;9 ?595r

6 "5;2 r" #5?r>5s ?r;r#9. – T5? 3 8"; "6? : >96r?5 B-r>99 II ">-r

9s 49" ;9 ;5sr"5 2->/59s5.


65/99

KLASIFIKASI TUMOR GANAS

• A;98; s"r58 898r 2rs59-> 292r 49".M9r" 24s502s5 B-r>99 ;?" ;5/5 "s : – B-r>99 I. B9"296 /r? ?-45?-5; 2rs59-> 6 sr59

;5s/" 99 II. Mr?29 9-9 5904"r"59 8r859->"-s 48r

;99 "?5 42s sr" >2-s >9-9-4 ;9 ;5sr"5 9-;4r.Dsr 42s "r45#" 92r-s5s ;99 7r9 28-24"9$ 2/9$;9 >r# 2#5">9. M2-s s25"r 42s ">?2 s9"#5?r>5s

– B-r>99 III. Br? 5904"r"59 8r859->"-s 48r. U42s96>>?965 ;59;59 ;9 "r45#" ;96 5904"rs5 ?r-rs5< ;9

;599 IV. Br? /9"2 ;5


66/99

PATOLOGI

• K/9629 292r s"r ;4# ;9-2rs59-> &%&&.

• Krs59-> s"r /rs4 ;r5 ?r/#9 ?5"4 ?;>>/r9 >2-s s"r$ 6 /r2>/9 ?; /59/7# s"r$ s;929 ?; "r-0 s"r

;5;?"29 /59 "s s"r ;9 s8r >4"5s9"r.• Krs59-> s"r "r45#" //r? /9"2:

– S?r>?"96 /rs4 ;r5 ?r-?5 6 /r/9"2/# 2 4>9 s/5 >ss

– S?r>?"96 /r/9"2 ">-r 6 /r4srs5 – Mss 6 ">/# >44 ;59;59 >959s5 4?5s9 -"-" – P96/r996 >44 ;59;59 6 ;58>r5 ?96/r9

?; ?r>29 – Br/9"2 4595"5s?4s"52 – S?r"596 2rs59-> /r/9"2 s?r"5 6 ;5 "s


67/99

GE+ALA KLINIS

• K4#9 "> ">-r 9s s"r : – Br" /;9 >9r9 – N6r5 ?5s"r5> – M9"# – K4#9 ?98r99 – A9-r2s5 – K4#9 >> – D5s#9 – S9;7 – H>">s5s – Rr5"s5 – L2s 2969

• G4 6 ;5"5>/429 -4# >"s"s5s ;?" /r? ?r">>/sr As85"s$ 52"rs -/s"r2"5


68/99

INFLAMMATORY BOWEL

DISEASE


69/99

DEFINISI J KLASIFIKASI

• P9625" 59>s5 69 >45/"29s4r9 8r9$ ;99 ?96//?s"596 /4> ;52"#5 4s IPDFKUI$ %%*

• S8r r5s /sr ;5/5 3 95s: – K-45"5s 4sr"5

– P9625" Cr-#9 – B54 s45" ;5/;29$ >2 ;5>s229

;4> 2"-r5 I9;"r>59" C-45"5s.


70/99

KOLITIS ULSERATIVA

• K-45"5s U4sr"5 >r?29 s"?9625" >9#9$ ;5>9 ss /sr>94>5 ?r;99 ;9 42$ 69

>96//29 ;5r /r;r#$ 2r>?r" ;9 ;>>.

• P9625" 595 /5s96 ;5>45 ;5 r2">

" 2-4-9 s5>-5; 9 /7# ;r5ss /sr ;9 2#5r96 >96/r 2s/59 " s4r# ss /sr.


71/99

KOLITIS ULSERATIVA

• S" sr99 /5s >9;;2 ;9 /r"$>96//29 ;5r #/"$ ;>> "595$ s25" ?r";9 ?r5"-95"5s r;9 s4?" ?r". S4>sr99$ ?9;r5" ">?2 s9" s25".

• Y9 4/5# sr59 "r;5 ;4# sr9996 ;5>45

/r"#?$ ;5>9 ?9;r5" >>54525 259599 9"2/9 5r /sr 69 s9"$ 2r> r599 ?; ?r"/7# ;9 "59 69 /r;r# ;9 /r49;5r.

• +52 ?9625" 595 "r/"s ?; r2"> ;9 2-4-9s5>-5;$ "59 >9259 9-r>4 " 2rs ;9 2r59.

T"?5 s4> " ;59"r 72" /9 5r /sr$

;r5 r2"> 24r 49;5r 69 >99;9 /962s4 ;r# >r# ;9 s4 ;r# ?"5#.G4 >> /r? ;>>$ /5s r599 " >4#"5;2 >984.


72/99

KOLITIS ULSERATIVA

• +52 ?9625" >96/r 2 ss /sr$ "59 4/5#492 ;9 ?9;r5" /9 5r /sr s/9621%% 245#r5.

• P9;r5" sr59 >94>5 2r> ?r" 69/r"$ 29 ?; r2"> 69 "rs 96r5$;5sr"5 259599 9"2 /9 5r /sr 69s9". P; >4> #r5?9 4 595 "5;2/r2r9.

• T59 ">?2 98r ;9 >99;9 99#$;r# ;9 49;5r. Y9 ?459 sr59 ;5">29

;4# "59 69 #>?5r s4r#96 /r5s5 ;r#;9 99#.P9;r5" /5s ;>>$ 92996>9r9 ;9 /r" /;996 /r2r9


73/99

CA KOLON

• K92r ss /sr r9>96//29 ;>> "24r96 99# ;r5 r2">$ 9>9

#rs ;5025r29 292r s/52>92599 ?96// ;5r/r;r#.


74/99


75/99

ETIOLOGY

• P96// ?9625" Cr-#9 "5;2;52"#5.P945"59 >>s"29 ?r#"59

?; "5 2>92599?96//96$ 65": K4599


76/99

SIGN

• N29 /r2r9• P9r99 /r" /;9.• P; ?>r52s9 0s52 ;5">29 /9-49 " rs ?9#

?; ?r" /59 /7#$ 4/5# sr59 ;5 s5s5 299.• S25"r s?r"5 ?9;r5" ?9625" Cr-#9 >>54525

>s4# ;5 s25"r 9s$ "r"> 0s"4 ;9 48" 0ssr?; 4?5s9 s4?" 49;5r 9s.• P9645" Cr-#9 ;5#/929 ;99 24599 "r"9" ?;

/59 "/# 45996$ s?r"5 /" >?;$ 24599?96r?9 " 55 ;9 ?9>?29 >54-5; >54-5;-s5s.

• P; 9292$ 44 s4r9 ?98r99 s?r"5s25" ?r" ;9 ;5r sr59 /29 >r?29 4 ">;9 /5s "5;2 >984 s> s245.G4 ">96 >9259 /r? ?r;99 s9;5$;>>$ 9>5 " ?r">/#9 69 4>/".


77/99


78/99

FISSURA ANUS

• >r?29 s" r/29 " 42/r99# 42s$ /-r-2 ?; 4?5s9 9s.

•

PENYEBABB5s96 ;5s//29 -4# 8;r 2r9/9 5r /sr 69 2rs ;9 /sr.F5ssr >96//29 -"-" >4592rs09"r ;r5 9s >94>5 29 ;9#4 595 29 >9645"29 ?96>/#9.

G


79/99

GE+ALA

• F5ssr >96//29 96r5 ;9?r;r#9 s4> " srs"4# /9 5r /sr.

Rs 96r5 29 /r49s9 s4>//r? >95" s>?5 //r? >;9 2>;59 >9#549 s>?5

s" /9 5r /sr /r52"96.

%yeriepigastrik

r599S;9

/r"


80/99

epigastrik

E9;-s8-?6 R6GI /59 "s Tr?5 ;99

9"s5;

9"-95s H

Pr/529

G4""?

9;-s8-?6

T5;2;

4s5 49"

Tr?5 ;999"s5;$ 9"-95s

H$ ->?r-4$ "9"5/5-"52 H. ?64-r5

Gs"r58 48r/5-?s6 48r

;s$ s5"-4-5$/5-?s5 H. ?64-r5

D-;94 48r$r-s5-9s$ "

59>s5;-;9>

4>/9

B5-?s5 H.

?64-r5

Tr?5 ;99

9"s5;$ 9"-95sH$ ->?r-4$

" 9"5/5-"52 H.?64-r5

Pr/529 G4""?

T5;2 ;4s5

49"

Pr"5>/929 :R9;-s8-?6$H.?64-r5$ sr>

s"r59$ 9-98->?459" ?"59"

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+52 "5;2s>/# ;4>

1* >59$?r"5>/929

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-/"5-94

Gs"r-59"s"594 /4;59


81/99

94 /4;59

C-9s4"sr-9

Tr98#

Pss9s-s"r58


82/99

59s"->8#

W5"#;r7

"/

U??r GI

9;-8-?6

C-9s5;r : s48"5r"r5-r?#6

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rs52-

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83/99

DIAGNOSA SEMENTARA

• Br;sr29 9>9s 2ss$ ;5; Mrs. D-/"0r >9;r5" 42s??"52> ;99 24#9 96r5 ;5

?5s"r> 69 "5>/4 ?r5-;52$>4 >9"# .


84/99

PEMERIKSAAN PENUN+ANG


85/99

PEMERIKSAAN PENUN+ANG

• A945s 4>/9 >r?29 s"?r-s;r ;5>9 85r9 4>/9 ;5#5s?s8r 49s9 ;r5 4>/9 ;9;-;9> s#59 >4# s> /5s

;52r.Pr-s;r 595 ;54229 #96 5242s96 /r" " /r49 "s/4> ;5422996 ?>/;#9.

•

H5"9 95s ;r# /5s >99"29;96 9>5 25/" ?r;r#9 42s.P>r5s9 ;r# 45996 /5s>9>29 ;96 H458-/8"r ?64-r5.

TREATMENT


86/99

TREATMENT

• A9"s5; >9r95 4$ >>?r8?" ?96>/#9;9 >9r95 >4# 92 22>/#9 ;r5 42s.

• A9"s5; 69 ;?" ;5sr?. – O/" 595 ;99 sr 29 >9"r429 s4r# s>

4>/9. – Y9 ?459 2" ;4# 9"r5> /52r/-9" ;9 24s5>

2r/-9"$ 69 59>.

– O/" 595 ;5sr? -4# 45r9 ;r#$ s#59 ?>259"rs >9rs /5s >96//29 ?r/#9 ;4>2s5>/99 s>/s ;r# ;9 >96//29

"r;596 424-s5s s59;r-> 4245ss. Kr9 5" -/"595 /5s96 "5;2 ;5929 ;4> >4# /sr s4>4/5# ;r5 //r? #r5.

TREATMENT


87/99

TREATMENT

• A9"s5; 69 "5;2 ;?" ;5sr?. – O/" 595 4/5# ;5s25 2r9 ?5996

4/5# s;525"$ "5;2 >96//29 424-s5s.

–

O/" 595 /r52"9 ;99 s> 4>/9>>/9"2 /#9 69 /r"#9 ;5 ;4>4>/9$ >9r95 2"55"s 85r985r9?98r99 ;9 >9r95 4 42s"9? >96//29 424-s5s.

T"?5 9"s5; 595 >>?9r#5 ?96r?9-/" 45996 >5s496 ""r8684459$ ;5-59 ;9" /s5 2 ;4> ;r#.

TREATMENT


88/99

TREATMENT

• A4>95> H;r-2s5;. – Mr?29 9"s5; 69 r4"5< >9 ;9 /962

;5929. T"?5 4>95> ;?" /r52"9;99 925/"29 #54996 929 ;94>s.

– Rs52- "5>/496 ?59 595 4/5# /sr

?; ?9;r5" 69 42-#-452 ;9 ?9;r5"?9625" 594 "r>s2 69 >9495#>-;545s.O/" 595 /5s >96//29 s>/45".

TREATMENT


89/99

TREATMENT

• M9s5> H5;r-2s5;. – Mr?29 9"s5; 69 4/5# >?9r#5 2/5s9 /9 5r/sr ""?5 /54 4/5# ;r5 ' 245 /5s>96//29 ;5r.

– S>4 2854 >9s5> ;5sr? 2 ;4>;r#$ s#59 -/" 595 #rs ;5/r529 ;4>;-s5s 2854 2?; ?9;r5" 69 >94>5

2rs29 594.B962 9"s5; 69 >99;9 >9s5>;9 4>95> #5;r-2s5;.

TREATMENT


90/99

TREATMENT

• A9"-95s H. – C-9"-#96 ;4# 85>"5;59$ r95"5;59$ -"5;59 ;9

95"5;59.O/" 595 >>?r8?" ?96>/#9 42s ;99>9r95 >4# s> ;9 95> ?98r99 ;5

;4> 4>/9 ;9 ;-;9>.

– D5>59> 1 245#r5 ;9 //r? ;59"r96 /5s;5?r-4# "9? rs? ;-2"r.

– C5>"5;59 /5s >>?9r#5 ?>/99 -/""r"9" ;r5 "/# >5s496 "-0459 9"2 s>$7r


91/99

TREATMENT

• O>?r-4 ;9 I9s-?r-4.Mr?29 -/" 69 s9" 2" >9#>/" ?>/9"2995> 69 ;5?r429 4>/9 9"2 >>/" s>.O/" 595 ;?" s8r "-"4 >9#>/" ?4?s9 s> ;9. Tr"> 4>/9 >5s496s59;r-> ,-4459rE445s-9.

• M5s-?r-s"-4.D5929 9"2 >98# 42s s"r52> 69 ;5s//29-4# -/"-/" 9"5 ?r;99 9-9s"r-5;.

O/" 595 ;5/r529 2?; ?9;r5" r"r5"5s 69>92-9s>s5 -/" 9"5 ?r;99 9-9s"r-5; ;-s5s "595. T"?5 -/" 595 "5;2 ;5929 ?; s> ?9;r5" r"r5"5s"rs/" 2r9 >96//29 ;5r ?; 3% ?9;r5".

TREATMENT


92/99

TREATMENT

• A9"5/5-"52.D5929 /54 ?96// "> "r;596 42s;4# H458-/8"r ?64-r5.P9-/"9 "r;5r5 ;r5 s" >8> " 4/5#9"5/5-"52 ;9 -/" 9"2 >9r95 "

>9"r454s5r s> 4>/9. Y9 ?459 /962 ;5929 ;4# 2->/59s5/5s>" s/s45s54" s95s s8r4?r-4 ;99"5/5-"52.

P9-/"9 595 /5s >9r95 4 42s$/#29 52 42s "5;2 >>/r529 rs?-9"r#;? ?9-/"9 s/4>96 " 52 42ssr59 >94>5 22>/#9.

TREATMENT


93/99

TREATMENT

• PEMBEDAHAN

59;52s5 ?>/;#9:

– >9"s5 2->?452s5 ;r5 42s ??"52>>5s496 ?r/"9 69 "5;2>>/r529 rs?-9 "r#;? ?>/r59 -/"" >94>5 22>/#9

– 245 " 4/5# ?r;r#9 2r9 42s

– 42s s"r52> 69 ;58r55 29 >9;59s

– 42s ??"52> 69 /r" ;9 sr59 2>/#9

KESIMPULAN


94/99

KESIMPULAN

• Mrs. D-/"0r >94>5 ;5s??s5$#>">s5s ;9 >49 69>9r# ?; ?9;r#9 s4r9

8r9 "s 65" 42s ??"52>.

SARAN


95/99

SARAN

• I;9"502s5 ;9 ?9#59;r9 >299 6>96//29 s2rs5 HCL /r4/5#9

• P9;5;529 >995 >9#59;r5 42-#-4;9 2/2 ;?">>?r4>/" ?96>/#9• P9"42s99 s"rs$ "2952 r42ss5 "

s;"5< 9"2 >9"s5 ?9r# ?s52-4-5s• A9"s5; 9"2 >9"r429 s>• P>/r59 A/ 6 s?s502 9"2 #.?64-r5• A9"-95s rs?"-r #5s">59 6 >9r95

s2rs5 s> -4# s4 ?r5"4

REFERENCES


96/99

REFERENCES

• Iss4/8#r$ Kr" +. Hrr5s-9 Pr59s5?Pr59s5? I4>P9625" D4>. EGC. +2r": %%%.

• Ks?r DL$ Br974; E$ F85 AS$ Hsr SL$L-9- DL$ +>s-9 +L$ ;5"-rs. Hrr5s-9@s Pr5985?4sO< I9"r94 M;5859. 1*"# ;. N7 Y-r2: M8Gr7

H544$ %%)• F85$ Ks?r$ Br974;$ " 4 %%! Hrr5s-9@s

Pr5985?4s -< I9"r94 M;5859 N7 Y-r2 : M8Gr7 H544

• M992s>- E$ S-"5?"- D. B2 Ar I4>

Ks#"9 T459 H5;9 T9-r-2 K?4 ;9L#r. FKUI. +2r" : %%).• H;5$ ?r-


97/99

REFERENCES

• Mrs8#44 S R9$ M A9;r7 Gr9"5. N""r@sI9"r94 M;5859. E;5s5 . C#59: S9;rs$ %%&.

• Ar"#r C G6"-9$ +-#9 E H44. B2 Ar F5s5-4-5K;-2"r9. E;5s5 11. +2r": EGC$ %%).

• Fr;r58 H Mr"595$ E;759 F Br"#-4->7. Ess9"54 -<

A9"->6 J P#6s5-4-6. E;5s5 (. A>r52 Sr52":Prs-9$ %1%.• S45>9 H. A45$ D4;56-9-$ A2/r H. Nr4$ R95 A.

A5. 1&&). Gs"r-9"r-4-5 H?"-4-5. +2r":S9 S"-

•

S;-6-$ Ar W. B2 Ar I4> P9625" D4>. FKUI. +2r" : %%*.• D6$ P"r582. A" G498 M;5859. EMS. %%3.• R-//59s$ K>r. P"-4-5 ;5s5 '. EGC. +2r": 1&&(.

D


98/99

D;58s"-r.8->. P9;r#9S4r9 Cr9. R"r5; : s" *$%%&.

• #""?:777.>;58599".8->.s-?#5"5s.R"r5;: As" * $ %%&.

• #""?:777.>;5859.8->. s-?#5"5s.R"r5; : As" *$ %%&.

•

777.7/>;.8->• 777.7r-9;59-s5s.8->

• 777.>;58s"-r.8->

THANK YOU

http://www.webmd.com/http://www.wrongdiagnosis.com/http://www.medicastore.com/http://www.medicastore.com/http://www.wrongdiagnosis.com/http://www.webmd.com/


99/99

THANK YOU

group 03 case 1a.ppt

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