Laporan Kasus Melena

LAPORAN

LAPORAN

KASUS

KASUS

“MELENA”

“MELENA”

Oleh: Diatri Eka Denta – 2101210033

Oleh: Diatri Eka Denta – 2101210033

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ANAMNESA



KU: $A$ (e"ikit(e"ikit 4air arna hitam 'eti( (eak + hari



RPS:

$A$ (e"ikit(e"ikit arna hitam 'eti( (eak + hari "i(ertai len"ir "an ti"ak

kera(# $A$ (ehari i(a leih "ari em'at kali# M-al 567& m-ntah 57# $AK

n%rmal ti"ak a"a !an!!-an#

Pa(ien (eel-m (akit men!atakan makan makanan (eharihari (aa# *er"a'at

n8eri "i a!ian -l- hati ter-tama ketika 'er-t k%(%n!& nam-n ketika "ieri

makan 'a(ien mera(a (e(ak#



Ria8at Pen8akit Dah-l-:



9a(triti( : 6



9an!!# Par-

: "i(an!kal



9an!!# 9inal: "i(an!kal



e'atiti( : "i(an!kal



Diaete( : "i(an!kal



i'erten(i : 6



Sakit 8an! (ama: "i(an!kal



Ria8at Pen!%atan :

Pa(ien (erin! men!k%n(-m(i %at lin-#

Pa(ien aran! k%ntr%l -nt-k 'en8akit

hi'erten(in8a#



Ria8at Pen8akit Kel-ar!a

:

PEMER)KSAAN ;)S)K 

 Tanda-tanda Vital

Ke(a"aran: <%m'%( menti(

 *ekanan "arah :120=.0 mm!

Na"i :103 >=menit& i(i 4-k-'&

re!-ler& (imetri(

S-h- : 3? @<

Perna'a(an :1. >=menit& "alam&

re!-ler& a"%min%t%rakal

Kea"aan -m-m

: *am'ak (akit

(e"an!

Status Generalis

Ke'ala : N8eri tekan ke'ala & ram-t ti"ak m-"ah "i4a-t& al%'e4ia #

aah : N8eri tekan (in-( #

Mata : K%n-n!tiBa '-4at 6=6& (klera ikterik =& R<L 6=6& R<*L 6=6& "iameter '-'il 3mm=3mm#

 *elin!a : N8eri tekan tra!-( =& n8eri tekan ma(t%i" =& (er-men =& (ekret =& memran tim'ani intak=intak# i"-n! : Sekret =& "eBia(i (e't-m & m-k%(a

hi'eremi( #

 Leher :

K9$ : *i"ak teraa#

 *ir%i" : *i"ak ter"a'at 'eme(aran#  P : +2 4m2O#

 Da"a :

 Par- :): Per!erakan "in"in! "a"a (imetri(& retrak(i i!a & 'e4t-( e>4aBat-m & 'e4t-( 4arinat-m & ('i"er neBi & (ikatrik( #

P: Kre'ita(i & ma((a & Cremit-( la'an! 'ar-kirikanan#

P: S%n%r 'a"a (el-r-h la'an! 'ar-#

A: $-n8i na'a( '%k%k Be(ik-ler 6=6& -n8i na'a( tamahan #

 ant-n! :): )4t-( 4%r"i( ti"ak terlihat

P: )4t-( 4%r"i( teraa "i )<S + linea mi"klaBik-la kiri P:$ata( ant-n! kiri "i )<S + linea mi"klaBik-la kiri& ata( ant-n! kanan "i )<S + linea (ternali( kanan#

A: S1& S2 n%rmal

 P-n!!-n!:): Per!erakan "in"in! '-n!!-n!

(imetri(& kelainan k%l-mna Bertera #

P: Kre'ita(i & ma((a & Cremit-( la'an! 'ar-kirikanan#

P: S%n%r 'a"a (el-r-h la'an! 'ar-#

A: $-n8i na'a( '%k%k Be(ik-ler 6=6& -n8i na'a( tamahan #

 A"%men:): A"%men "atar& 4a'-t me"-(a &

(ikatrik( & Benekta(i #

P: Din"in! a"%men (-'el& n8eri tekan 6 re!i% e'i!a(tri-m& n8eri tekan M4$-rne8 & he'ar "an lien ti"ak teraa& all%tement =& n8eri ket%k <A =#

P: A(4ite( #

A: $i(in! -(-( 6& / kali 'er menit#

 Ek(tremita(: <R* F2”& 4l-in! Gn!er & e"ema

'retiia =& reHek( 'atella 62=62& (ian%(i( 'eriCer & eritema 'almar 6=6

PEMER)K 

SAAN

PENUNA

N9

La%rat%ri-m:   : I&,  <* : 1/&/  Eritr%(it : 2&22  *r%m%(it : 1#3+0#000  9DS : .1  S9O* : 2.  S9P* : 3,  Ure-m : /I  Natri-m : 13I  Kali-m : +&/  <l : 10/

 WORKING DIAGNOSA

O(erBa(i Melena

Dia!n%(i( $an"in!:

Melena e#4# (-('ek !a(triti( er%(iC "" r-'t-r Bari(e( e(%Ca!-(

Ren4ana Pemerik(aan  *amahan:

En"%(k%'i& A('ira(i i(i lam-n!

Penatalaksanaan

);D Na<l 0&,J +00 ml=12 am Ome'ra%le 2>I0 m!& )

S-kralCat I>1+ 44

La4t-la4 3><)  lakt-l%(a

 *ran(amin 3>+00 m!& )

 *ran(C-(i PR< "en!an tar!et  10 !="l

Pr%!n%(i(:

-% a" Bitam : "-ia a" %nam -% a" C-n4ti%nam : "-ia

DE;)N)S)

Per"arahan (al-ran 4erna a!ian ata( 5"i"eGni(ikan (ea!ai 'er"arahan

8an! tera"i "i (eelah proksimal ligamentum Treitz 'a"a duodenum distal#

Sea!ian e(ar 'er"arahan (al-ran 4erna aha!ian ata( tera"i (ea!ai

akiat 'en8akit ulkus peptikum 5PUD& peptic ulcer disease7 58an!

"i(eakan %leh H. Pylori ata- 'en!!-naan %at%at antiinHama(i n%n

(ter%i" 5OA)NS7 ata- alk%h%l7#

9AM$ARAN UMUM

Per"arahan (al-ran 4erna a!ian ata( "a'at ermaniCe(ta(i klini( m-lai "ari

8an! (e%lah rin!an& mi(aln8a 'er"arahan ter(amar (am'ai 'a"a kea"aan

8an! men!an4am hi"-'#

emateme(i(

 a"alah m-ntah "arah (e!ar 5merah (e!ar7 ata- hematin

5hitam (e'erti k%'i7 8an! mer-'akan in"ika(i a"an8a 'er"arahan (al-ran

4erna a!ian ata( ata- 'r%k(imal li!ament-m *reit#

Per"arahan (al-ran 4erna a!ian ata( 5S<$A7

& ter-tama

"ari

duodenum

 _{"a'at '-la ermaniCe(ta(i "alam ent-k}

melena

_#

emat%keia

 5"arah (e!ar kel-ar 'er an-m7 ia(an8a era(al "ari

'er"arahan (al-ran 4erna a!ian aah 5k%l%n7# Mar%%n (t%%l( 5Ce(e(

E*)OLO9)

 D-%"enal -l4er 520 – 30 J7

 9a(tri4 ata- "-%"enal er%(i%n( 520 – 30 J7  ari4e( 51+ – 20 J7

 9a(tri4 -l4er 510 – 20 J7

 Mall%r8 – ei(( tear 5+ – 10 J7  Er%(iBe e(%'ha!iti( 5+ – 10 J7  An!i%ma 5+ – 10 J7

 Arteri%Ben%-( malC%rmati%n 5F + J7  9a(tr%inte(tinal (tr%mal t-m%r(  NSA)D

9EALA KL)N)S

1#

emateme(i(

2#

emat%4heia

3#

Melena

PENE9AKKAN D)A9NOSA

)n('ek(i m-ntahan 'a(ien

ata- 'ema(an!an (elan!

na(%!a(tri4 5N9*&

na(%!a(tri4 t-e7 "an

"etek(i "arah 8an! ela(

terlihat 4airan er4am'-r

"arah& ata- “am'a( k%'i”

Pa"a (em-a 'a(ien

"en!an 'er"arahan

(al-ran

!a(tr%inte(tinal 59)*7

'erl- "ima(-kkan

'i'a na(%!a(trik

"en!an melak-kan

a('ira(i i(i lam-n!

1# Menent-kan tem'at 'er"arahan

2# Mem'erkirakan -mlah 'er"arahan "an a'akah 'er"arahan telah erhenti 3# <%nBenti%nal ra"i%!ra'hi4

ima!in! ia(an8a ti"ak terlal- "i-t-hkan

I# Mem'ertahankan (al-ran naCa( 'aten "an re(t%ra(i B%l-me intraBa(4-lar

ENDOSKOP)



)n"ika(i : 'er"arahan (al-ran 4erna a!ian ata( 5S<$A7&

"8('e'(ia& "i(Ca!ia& %"in%Ca!ia& n8eri e'i!a(tri-m kr%ni(&

ke4-ri!aan %(r-k(i %-tlet& (-rBe8 en"%(k%'i& 4-ri!a

ke!ana(an& "an n8eri "a"a ti"ak kha(#



K%ntra )n"ika(i A(%l-t: ti"ak k%%'eratiC& '(ik%'at& aler!i %at

'reme"ika(i& (8%k& inCark mi%kar" ak-t& re('irat%ri "i(tre((&

"an 'er"arahan ma(iC



K%ntra )n"ika(i RelatiC: kelainan k%l-mna Berterali(& !a!al

 ant-n!& (e(ak naCa(& !an!!-an ke(a"aran& inCek(i ak-t&

ane-ri(ma a%rta t%rakali(& t-m%r me"ia(tin-m& (ten%(i(

Pe'ti4 Ul4er

GAMBARAN

ENDOSKOPI

9amaran en"%(k%'i 'a"a 'a(ien !a(tri4 -l4er akiat 'en!!-naan NSA)D( "an te(t #P8l%ri ne!atiBe#

9amaran en"%(k%'i 'a"a 'a(ien "-%"enal -l4er "en!an te(t #P8l%ri '%(itiC teta'i ti"ak a"a ria8at 'en!!-naan NSA)D(

D-%"enal Ul4er

GAMBARAN

ENDOSKOPI

GAMBARAN

ENDOSKOPI

9amaran en"%(k%'i "ari !a(tri4 Bari4e( "an e(%'ha!eal Bari4eal li!ati%nrelate" -l4er(

 ika ha(il en"%(k%'i ne!atiC& 'erl- "i'ertiman!kan

a"an8a t-m%r inte(tinal 5(4hann%ma& lei%mi%ma&

limC%ma mali!na& kar(in%ma7# M%"alita( 'en4itraan

lain 8an! "a'at "i!-nakan a"alah ra"i%!raG

"en!an C%t% '%l%( a"%men& <* (4an& MR)&

ata-en"%(k%'i ka'(-l "an double balloon enteroscopy #

D)A9N

OSA

$AND)

N9

PENA*ALAKSANAAN



Pertamatama har-( "ilak-kan

re(-(ita(i hem%"inamik "en!an

"arah ata- 4airan 8an! "ierikan

(e4ara intraBena

Ak(e( ) "ilak-kan "en!an 'ema(an!an ) line#

Re(-(ita(i "ilak-kan "en!an melak-kan 'enamahan B%l-me intraBa(k-lar "en!an n%rm%(alin ata- lar-tan Rin!er laktat&

tran(C-(i PR< (etelah "ilak-kan 4r%((mat4hin! hin!!a "i4a'ai ka"ar  tar!et 10 !="l 'a"a ka(-( r-'t-r Bari(e( "an 12 !="l 'a"a ka(-( n%n r-'t-r Bari(e(& (erta k%rek(i k%a!-l%'ati "en!an tran(C-(i Cre(h

Cr%en 'la(ma ata- k%n(entrat tr%m%(it hin!!a ka"ar tr%m%(it +0#000=mm3

A'aila ter"a'at

hemateme(i(

PENA*ALAKSANAAN

$ila( lam-n! "en!an N9*

(emari "ilak-kan int-a(i -nt-k

melin"-n!i alan na'a( a'aila

tera"i (8%k& hemateme(i( ma(iC&

ata- 'en-r-nan ke(a"aran

 *era'i Lan-tan

5(e(-ai

'en8ea7

melen

a

r-'t-r Bari(e( e(%Ca!-(

%ktre%ti"a "an antii%tik "itamah "en!an en"%(k%'i tera'e-tik 5li!a(i Bari(e( e(%Ca!-(7

n%n r-'t-r Bari(e(

(it%'r%tekt%r er-'a (-kralCat ata- te'ren%n& anta(i"a& (erta inek(i Bitamin K 'a"a 'a(ien "en!an 'en8akit he'ar kr%nik ata- (ir%(i( he'ar

-lk-(

'e'tik-m inhiit%r '%m'a 'r%t%n 5%me'ra%le7 "an en"%(k%'i tera'e-tik 5inek(i e'ineCrin&

ka-teri(a(i& "an 'ene'itan 'em-l-h "arah7 !a(triti(

er%(iC 

inhiit%r '%m'a 'r%t%n ata-anta!%ni( 2#

 *era'i 4airan ini(ial Na<l 0&,J  menin!katkan B%l-me 4airan

'en!-k-ran ka"ar 

 ika  5'a"a ka(-( ini7  tran(C-(i "arah hin!!a "i4a'ai tar!et  10 !="l 'a"a ka(-( r-'t-r Bari(e( ata- 12 !="l 'a"a