Laporan Kasus

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CHRONIC VENOUS INSUFFICIENCY

Pembimbing :

dr. Nyoto Widyo Astoro, Sp.PD-KHOM, FINASIM

Disusun Oleh :

Nyoman Aditya Sindunata

FK UPH -

FK UPH - !""

!""!#"!!#

!#"!!#

KEPANITERAAN KLINIK ILMU PENYAKIT DALAM

PERIODE 23 MEI – 6 AGUTU 2!"6

RUMA# AKIT PUAT ANGKATAN DARAT

GATOT OE$ROTO

%AKULTA KEDOKTERAN UNI&ERITA PELITA #ARAPAN

'AKARTA

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LEM$AR PENGEA#AN KOORDINATOR KEPANITERAAN LEM$AR PENGEA#AN KOORDINATOR KEPANITERAAN

DEPA

DEPARTEMEN ILMU RTEMEN ILMU PENYAPENYAKIT DKIT DALAMALAM

L()*+(n ,(sus -eng(n .u-ul: L()*+(n ,(sus -eng(n .u-ul: Chronic Venous Insufficiency Chronic Venous Insufficiency

Disusun un/u, Memenuhi 0(+(/ Mengi,u/i U.i(n Ke)(ni/e+((n Klini, Disusun un/u, Memenuhi 0(+(/ Mengi,u/i U.i(n Ke)(ni/e+((n Klini,

De)(+/emen Ilmu Pen0(,i/ D(l(m De)(+/emen Ilmu Pen0(,i/ D(l(m

Rum(h (,i/ Pus(/ Ang,(/(n D(+(/ G(/*/ *eb+*/* '(,(+/( Rum(h (,i/ Pus(/ Ang,(/(n D(+(/ G(/*/ *eb+*/* '(,(+/(

Disusun *leh: Disusun *leh: N0*m(n A

N0*m(n A-i/0( in-un(/( %KUP# 2-i/0( in-un(/( %KUP# 2!""!1"!""!1"!!12!!12

$%&a' dis%tu(ui o&%' P%m)im)in*+ $%&a' dis%tu(ui o&%' P%m)im)in*+ N

Naamma a PP%%mm))iimm))iinn* * $$aanndda a ttaann**aan n $$aann****aa&&

dr

dr. . NyotNyoto o WW. . A., A., Sp. Sp. PD-KPD-KHOM, HOM, FINAFINASIM SIM ... ... ...

M%n*%ta'ui M%n*%ta'ui

K%pa&a D%part%m%n I&mu P%nyait Da&am RSPAD atot So%)roto aarta K%pa&a D%part%m%n I&mu P%nyait Da&am RSPAD atot So%)roto aarta

dr. H. Sya/ruddin A. R. L%&osutan, Sp.PD-K0H, MARS, FINASIM dr. H. Sya/ruddin A. R. L%&osutan, Sp.PD-K0H, MARS, FINASIM

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KA$

KA$A P0NA P0NAN$AR AN$AR

Pu.i s0u,u+ )en0usun )(n.(/,(n ,eh(-i+(/ Tuh(n Y(ng M(h( Es( ,(+en( Pu.i s0u,u+ )en0usun )(n.(/,(n ,eh(-i+(/ Tuh(n Y(ng M(h( Es( ,(+en( (/(s be+,(/ -(n +(hm(/N0( )en0usun (,hi+n0( -()(/ men0eles(i,(n )en0usun(n (/(s be+,(/ -(n +(hm(/N0( )en0usun (,hi+n0( -()(/ men0eles(i,(n )en0usun(n l()*+(n ,(sus -eng(n .u-ul

l()*+(n ,(sus -eng(n .u-ul Chronic Venous InsufficiencyChronic Venous Insufficiency44

Tu.u(n -(+i )enulis(n l()*+(n ,(sus ini (-(l(h un/u, memenuhi /ug(s -(n Tu.u(n -(+i )enulis(n l()*+(n ,(sus ini (-(l(h un/u, memenuhi /ug(s -(n s0(

s0(+(/ +(/ -(l-(l(m (m menmenem)em)uh uh ,e),e)(ni/(ni/e+((e+((n n ,li,lini, ni, -i -i De)De)(+/e(+/emen men PenPen0(0(,i/ ,i/ D(lD(l(m(m Rum(h (,i/ Pus(/ Ang,(/(n D(+(/ G(/*/ *eb+*/* '(,(+/(4

Rum(h (,i/ Pus(/ Ang,(/(n D(+(/ G(/*/ *eb+*/* '(,(+/(4 Pen0

Pen0usun men0(-(+usun men0(-(+i i b(h5( )en0ub(h5( )en0usun(n l()*+(n ,(sus sun(n l()*+(n ,(sus ini b(i, ini b(i, -(+i segi-(+i segi isi -(n b(h(s(n0( s(ng(/ .(uh -(+i sem)u+n(4 T(n)( b(n/u(n -(n bimbing(n -(+i isi -(n b(h(s(n0( s(ng(/ .(uh -(+i sem)u+n(4 T(n)( b(n/u(n -(n bimbing(n -(+i )ih(,

)ih(, l(in l(in suli/ suli/ +(s(n0( +(s(n0( b(gi b(gi )en0usun )en0usun un/u, un/u, men0eles(i,(n men0eles(i,(n l()*+(n l()*+(n ,(sus ,(sus iniini *leh ,(+en( i/u )en0usun men0(m)(i,(n u()(n /e+im( ,(sih ,e)(-( -+4 N0*/* *leh ,(+en( i/u )en0usun men0(m)(i,(n u()(n /e+im( ,(sih ,e)(-( -+4 N0*/* 7

7ii-0-0* * AAs/s/**++**  ))44PPDDKK##OOMM  %%ININAAIM IM (/(/((s s bbimimbbiinngg((nnn0n0( ( --((l(l(mm men0eles(i,(n l()*+(n ,(sus ini4

men0eles(i,(n l()*+(n ,(sus ini4 A,h

A,hi+n0i+n0( ( )en)en0us0usun un be+be+h(+(h(+() ) l()l()*+(*+(n n ,(su,(sus s ini ini -()-()(/ (/ be+be+m(nm(n8((/ 8((/ b(gb(gii sem

semu( u( )ih)ih(,4 (,4 Pen0Pen0usuusun n .ug.ug( ( be+be+h(+h(+() () menmen-()-()(/,(/,(n (n ,+i,+i/i, /i, -(n -(n s(+(s(+(n n 0(n0(ngg memb(ngun un/u, ,esem)u+n((n )en0usun(n l()*+(n ,(sus ini4

memb(ngun un/u, ,esem)u+n((n )en0usun(n l()*+(n ,(sus ini4

'(,(+/( "! 'uli 2!"6 '(,(+/( "! 'uli 2!"6

Pen0usun Pen0usun

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DAF$AR ISI DAF$AR ISI

L%m)ar

L%m)ar P%n*%sa'anP%n*%sa'an...i...i Kata

Kata P%n*antarP%n*antar...ii...ii Da/tar

Da/tar Isi...Isi...iii...iii 1a) I

1a) I P%nda'u&uan..."P%nda'u&uan..." 1a)

1a) I I Laporan Kasus...Laporan Kasus...... I.

I. Id%ntitas Id%ntitas Pasi%n...Pasi%n...... II.

II. Anamn%sis...Anamn%sis...... III.

III. P%m%risaan P%m%risaan Fisi...Fisi...22 I3

I3. . P%m%risaan P%m%risaan P%nun(an*...P%nun(an*...4....4 3

3. . R%sum%...R%sum%... "!"! 3I.

3I. Da/tar Da/tar Masa&a'...Masa&a'... "!"! 3II.

3II. Dia*nosis Dia*nosis K%r(a...K%r(a... "!"! 3III.

3III. P%nata&asaP%nata&asanaan...naan...""...."" I5.

I5. Pro*nosisPro*nosis...""..."" 5.

5. $inda $inda Lan(ut...Lan(ut...""..."" 5I.

5I. P%n*a(ian...P%n*a(ian..."6..."6 1a) III

1a) III $in(auan $in(auan Pustaa...Pustaa...".." I.

I. Anatomi Anatomi dan dan Fisio&o*i Fisio&o*i 33%na.%na..."..." II.

II. Pato/isio&o*i..Pato/isio&o*i...  III.

III. Mani/%staMani/%stasi si K&inis...K&inis...2...2 I3

I3. . Dia*nosis...Dia*nosis...7...7 3

3. . Dia*nosis Dia*nosis 1andin*...1andin*...8"...8" 3I.

3I. $a$ata&asana...ta&asana...8...8 1a) I3

1a) I3 P%nutup...87P%nutup...87 Da/tar

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1A1 I 1A1 I

P0NDAHULUAN P0NDAHULUAN

Chronic venous insufficiency

Chronic venous insufficiency 9&I; me+u)(,(n )en0(,i/ ,+*ni, -im(n( 9&I; me+u)(,(n )en0(,i/ ,+*ni, -im(n( /e+

/e+-()-()(/ (/ g(ng(ngguggu(n (n )(-)(-( ( <en<en( ( 0(n0(ng g men0men0eb(eb(b,(b,(n n be+be+b(gb(g(i (i m(nm(ni8esi8es/(s/(si i ,li,linisnis be+g(n/ung

be+g(n/ung )(-( )(-( /ing,(/ /ing,(/ ,e)(+(h(nn0(4 ,e)(+(h(nn0(4 Pen0eb(b Pen0eb(b &I &I (-(l(h (-(l(h mul/i8(,/*+i(l mul/i8(,/*+i(l -(n-(n 8(,/*+8(,/*+ /e+sebu/ -()(/ s(ling mem)eng(+uhi s(/u s(m( l(in4 A-()un 8(,/*+ 8(,/*+8(,/*+ /e+sebu/ -()(/ s(ling mem)eng(+uhi s(/u s(m( l(in4 A-()un 8(,/*+ 0(ng be+)e+(n (-(l(h insu8isiensi ,(/u) <en(

0(ng be+)e+(n (-(l(h insu8isiensi ,(/u) <en( *bs/+u*bs/+u,si ,si )(-( <en( )(-( <en( -(n -is8ungsi-(n -is8ungsi )*m)(

)*m)( */*/4 */*/4 #(l #(l ini ini -()(/ -()(/ /e+.(-i /e+.(-i se(+( se(+( )+ime+ )+ime+ /(n)( /(n)( seb(b seb(b 0(ng 0(ng .el(s .el(s (/(u)un(/(u)un se,

se,un-un-e+ (,ib(e+ (,ib(/ / (-((-(n0n0( ( /+(/+(um(um(  *bs*bs/+u/+u,si,si  +i5(+i5(0(0(// deep deep venouvenous s throthrombosmbosisis 9D&T; sebelumn0(4

9D&T; sebelumn0(4

M(ni8es/(si ,linis 0(ng /e+.(-i

M(ni8es/(si ,linis 0(ng /e+.(-i mul(i -(+i /imbuln0( <en( +e/i,ule+ <(+isesmul(i -(+i /imbuln0( <en( +e/i,ule+ <(+ises )e+ub(h(n

)e+ub(h(n ,uli/ ,uli/ hingg( hingg( /e+.(-in0( /e+.(-in0( ul,us ul,us <en(4 <en(4 ei+ing ei+ing -eng(n -eng(n )e+,emb(ng(n)e+,emb(ng(n )en0(,i/

)en0(,i/ ge.(l( ge.(l( 0(ng 0(ng /imbul /imbul (,(n (,(n m(,in m(,in )(+(h4 )(+(h4 P(-( P(-( (,hi+n0( (,hi+n0( .i,( .i,( /e+.(-i /e+.(-i ul,usul,us (,(n (-( +esi,* /e+.(-in0( )en0eb(+(n in8e,si 0(ng -()(/ men0eb(b,(n -is(bili/(s (,(n (-( +esi,* /e+.(-in0( )en0eb(+(n in8e,si 0(ng -()(/ men0eb(b,(n -is(bili/(s -(n mung,in be+u.ung )(-( (m)u/(si4

-(n mung,in be+u.ung )(-( (m)u/(si4 Pen

Pen(ng(ng(n(n (n(n &I &I be+be+g(ng(n/un/ung g -(+-(+i i ,e/,e/e)(e)(/(n /(n -i(-i(gn*gn*sis sis se*+se*+(ng (ng -*,-*,/e+/e+ m(,( -(+i i/u s(ng(/l(h )en/ing un/u, mengen(l -(n )(h(m mul(i -(+i -e8inisi m(,( -(+i i/u s(ng(/l(h )en/ing un/u, mengen(l -(n )(h(m mul(i -(+i -e8inisi )(/*8isi*l*gi

)(/*8isi*l*gi m(ni8es/(si m(ni8es/(si ,linis ,linis ,l(si8i,(si ,l(si8i,(si hingg( hingg( /(/(l(,s(n( /(/(l(,s(n( &I4 &I4 T(T(/(l(,s(n(/(l(,s(n( &I

&I -ib(g-ib(gi i men.(-men.(-i i )en-e)en-e,(/(n 0(i/u ,(/(n 0(i/u ,*nse,*nse+<(/i8 -(n +<(/i8 -(n in/e+<in/e+<ensi4 Pen-e,(/(nensi4 Pen-e,(/(n ,*

,*nsnse+e+<(<(/i/i8 8 mememimilili,i ,i /u/u.u.u(n (n unun/u/u, , mmenenghgh(m(mb(b(/ / )+)+*g*g+e+esi si )e)en0n0(,(,i/ i/ -(-(nn mem

mem)e+/)e+/(h((h(n,(n,(n n ,u,u(li/(li/(s (s hi-hi-u) u) )(si)(sien en b(hb(h,(n ,(n menmengemgemb(lib(li,(n ,(n 8un8ungsi gsi 0(n0(ngg

/(-/(-in0in0( ( /e+/e+g(ng(ngguggu4 4 ((/ ((/ )en)en-e,-e,(/(n (/(n ini ini g(gg(g(l (l m(,m(,( ( (,((,(n n be+be+ub(ub(h h menmen.(-i.(-i )en-e,(/(n in/e+<ensi -im(n( -()(/ -il(,u,(n )embe-(h(n4

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1A1 II 1A1 II

LAPORAN KASUS LAPORAN KASUS

I.

I. IdId%n%ntititatas s PaPasisi%n%n

−

− N(m( P(sien N(m( P(sien : N04 : N04  # # −

− ''eenniis s KKeell((mmiinn : : PPee++eemm))uu((nn −

− UUssii( ( = = TT((nngggg((l l LL((hhii++ : : 66" " //((hhuun n = = ""6 6 AAgguuss//uus s "">>??@@ −

− N*4 Re,(m Me-is N*4 Re,(m Me-is : 2 – >6 – BB: 2 – >6 – BB −

− AAgg((mm(( : : IIssll((mm −

− PPee,,ee++..((((nn : : IIbbu u RRuumm((h h TT((nngggg(( −

− AAll((mm((// : : ''((//iibbeenniinng g $$((++uu −

− T(ngg(l M(su, RumT(ngg(l M(su, Rum(h (,i/(h (,i/ : " 'uni 2!"6 : " 'uni 2!"6 )u,ul "34!! )u,ul "34!! 7I$7I$

II

II. . AnAnamamn%n%sisiss

Au/*(n(mnesis )(-( /(ngg(l 3 'uni

Au/*(n(mnesis )(-( /(ngg(l 3 'uni 2!"6 )u,ul "34!! 7I$2!"6 )u,ul "34!! 7I$ Ke

Keluluh(h(n Un U/(/(mm(( : $: $eneng,g,(, (, )()(-( -( ,(,(,,i ,i ,i+i+i si see.(.(, , ? b? buul(l(n n MRMR A4

A4 RiRi5(05(0(/ Pen(/ Pen00(,i(,i/ e,/ e,(+((+(ngng

P(sien -(/(ng ,e P*li,lini, Pen0(,i/ D(l(m RPAD )(-( /(ngg(l " 'uni P(sien -(/(ng ,e P*li,lini, Pen0(,i/ D(l(m RPAD )(-( /(ngg(l " 'uni 2!"6 )u,ul "34!! 7I$4 P(sien -(/(ng -eng(n ,eluh(n beng,(, )(-( /ung,(i ,i+i 2!"6 )u,ul "34!! 7I$4 P(sien -(/(ng -eng(n ,eluh(n beng,(, )(-( /ung,(i ,i+i b(5(h

b(5(h se.(, se.(, 3 3 bul(n bul(n l(lu4 l(lu4 $eng,(, h(n$eng,(, h(n0( 0( )(-( )(-( /ung,(i /ung,(i ,i+i ,i+i /ung,(i /ung,(i ,(n(n ,(n(n /i-(, /i-(, (-( ,eluh(n4 $eng,(, /imbul )e+l(h(n mul(i -(+i )unggung ,(,i hingg( (,hi+n0( (-( ,eluh(n4 $eng,(, /imbul )e+l(h(n mul(i -(+i )unggung ,(,i hingg( (,hi+n0( be+/(mb(h

be+/(mb(h -(n -(n /e+us /e+us n(i, n(i, hingg( hingg( -i -i b(5(h b(5(h lu/u/ lu/u/ se.(, se.(, 2 2 bul(n bul(n l(lu4 l(lu4 $eng,(, $eng,(, be+/(mb(h

be+/(mb(h s((/ s((/ )(sien )(sien be+-i+i be+-i+i l(m( l(m( (/(u (/(u be+.(l(n be+.(l(n -()(/ -()(/ be+,u+(ng be+,u+(ng s((/ s((/ )(sien)(sien -u-u, l(lu men(i,,(n /ung,(in0(4 A5(ln0( beng,(, m(sih -()(/ be+,u+(ng -(n -u-u, l(lu men(i,,(n /ung,(in0(4 A5(ln0( beng,(, m(sih -()(/ be+,u+(ng -(n men-e,(/i u,u+(n /ung,(i ,(n(n n(mun l(m(,el(m((n sem(,in suli/ ,emb(li men-e,(/i u,u+(n /ung,(i ,(n(n n(mun l(m(,el(m((n sem(,in suli/ ,emb(li -(n en-e+ung mene/()4 P(sien me+(s( /ung,(i ,i+in0( be+/(mb(h be+(/ -(n mul(i -(n en-e+ung mene/()4 P(sien me+(s( /ung,(i ,i+in0( be+/(mb(h be+(/ -(n mul(i /e+(s( n0e+i

/e+(s( n0e+i se.(, beng,(, be+/(mb(se.(, beng,(, be+/(mb(h sehingg( bel(,(ng(h sehingg( bel(,(ng(n n )(sien men.(-i suli/)(sien men.(-i suli/ be+.(l(n4 Ti-(,

be+.(l(n4 Ti-(, (-( ,eme+(h(n )e+ub(h(n 5(+n( ,uli/ m(u)un lu(-( ,eme+(h(n )e+ub(h(n 5(+n( ,uli/ m(u)un lu,( )(-( /ung,(i4,( )(-( /ung,(i4 ebelumn0( 6 bul(n l(lu )(sien )e+n(h meng(l(mi ge.(l( se+u)( be+u)( ebelumn0( 6 bul(n l(lu )(sien )e+n(h meng(l(mi ge.(l( se+u)( be+u)( beng,(, -ise+/(i n0e+i )(-( /ung,(i ,i+i4 ((/ i/u ge.(l( 0(ng -i(l(mi /i-(, se)(+(h beng,(, -ise+/(i n0e+i )(-( /ung,(i ,i+i4 ((/ i/u ge.(l( 0(ng -i(l(mi /i-(, se)(+(h s((/ ini4 P(sien /el(h be+*b(/ ,e -*,/e+ -(n -i,(/(,(n /e+-()(/ g(nggu(n )(-( s((/ ini4 P(sien /el(h be+*b(/ ,e -*,/e+ -(n -i,(/(,(n /e+-()(/ g(nggu(n )(-( )embuluh

)embuluh <en(4 <en(4 TeTel(h l(h -il(,u,(n -il(,u,(n UG UG -il()*+,(n -il()*+,(n (-(n0( (-(n0( m(s(l(h m(s(l(h )(-()(-( )embuluh

)embuluh <en( <en( n(mun n(mun /i-(, /i-(, (-( (-( sumb(/(n4 sumb(/(n4 P(sien P(sien /i-(, /i-(, ing(/ ing(/ *b(/ *b(/ 0(ng0(ng -ib

(7)

,eluh(n be+,u+(ng -(n )(sien -i)ul(ng,(n4 P(sien /i-(, minum *b(/ +u/in un/u, ,eluh(n be+,u+(ng -(n )(sien -i)ul(ng,(n4 P(sien /i-(, minum *b(/ +u/in un/u, )en0(,i/ ini4

)en0(,i/ ini4

P(sien .ug( mengeluh,(n n0e+i )(-( lu/u/ ,i+i se.(, " /(hun l(lu4 N0e+i P(sien .ug( mengeluh,(n n0e+i )(-( lu/u/ ,i+i se.(, " /(hun l(lu4 N0e+i -i+(s( /(.(m4 N0e+i /imbul /e+u/(m( se/el(h bebe+()( l(m( be+.(l(n be+/(mb(h -i+(s( /(.(m4 N0e+i /imbul /e+u/(m( se/el(h bebe+()( l(m( be+.(l(n be+/(mb(h s((/ -ige+(,,(n -(n be+,u+(ng s((/ -iis/i+(h(/,(n4 em(,in l(m( n0e+i be+/(mb(h s((/ -ige+(,,(n -(n be+,u+(ng s((/ -iis/i+(h(/,(n4 em(,in l(m( n0e+i be+/(mb(h sehingg( )(-( (,hi+n0( )(sien engg(n un/u, be+.(l(n .(uh -(n en-e+ung -u-u, sehingg( )(-( (,hi+n0( )(sien engg(n un/u, be+.(l(n .(uh -(n en-e+ung -u-u, (/(u be+b(

(/(u be+b(+in+ing g s((/ -i s((/ -i +um+um(h4 P(sien su-(h (h4 P(sien su-(h be+be+*b(*b(/ / ,e ,e -*,-*,/e+ /e+ *+/*+/*)e*)e-i -i l(lul(lu -is(+(n,(n un/u, *)e+(si lu/u/ n(mun )(sien men*l(, -(n belum (-( +en(n( -is(+(n,(n un/u, *)e+(si lu/u/ n(mun )(sien men*l(, -(n belum (-( +en(n( *)e+(si4

*)e+(si4 P(s

P(sien ien /el/el(h (h menmengi-gi-() () -i(-i(be/ebe/es s melmelli/li/us us se.(se.(, , "6 "6 /(h/(hun un l(ll(lu4 u4 AA55(ln0(ln0(( )(sien mengeluh,(n

)(sien mengeluh,(n mu-(h me+(s( mu-(h me+(s( h(us b(n0(, h(us b(n0(, minum b(n0(, minum b(n0(, m(,(n b(n0(, m(,(n b(n0(, ,ening -(m ,ening lebih -(+i " ,(li -i m(l(m h(+i4 L(lu se/el(h -il(,u,(n ,ening -(m ,ening lebih -(+i " ,(li -i m(l(m h(+i4 L(lu se/el(h -il(,u,(n )eme+i,s((n

)eme+i,s((n l(b*+(/*+ium l(b*+(/*+ium -i-()(/,(n -i-()(/,(n gul( gul( -(+(h -(+(h /inggi /inggi -(n -(n )(sien )(sien -i-i(gn*sis-i-i(gn*sis -i(be/es melli/us4 e.(, s((/ i/u )(sien +u/in ,*n/+*l ,e -*,/e+ -(n ,*nsumsi *b(/ -i(be/es melli/us4 e.(, s((/ i/u )(sien +u/in ,*n/+*l ,e -*,/e+ -(n ,*nsumsi *b(/ +u/in4 ((/ ini )(sien +u/in meng,*nsumsi ((+b*se -(n gul( -(+(h /e+,*n/+*l +u/in4 ((/ ini )(sien +u/in meng,*nsumsi ((+b*se -(n gul( -(+(h /e+,*n/+*l -eng(n b(i,4

-eng(n b(i,4

$4

$4 RiRi5(05(0(/ P(/ Pen0en0(,i(,i/ D(/ D(huhululu

P(sien men0(ng,(l (-(n0( +i5(0(/ -(+(h /inggi s/+*,e )en0(,i/ .(n/ung P(sien men0(ng,(l (-(n0( +i5(0(/ -(+(h /inggi s/+*,e )en0(,i/ .(n/ung gin.(l -(n (le+gi4 Ti-(, (-( +i5(0(/ ,eel(,((n *)e+(si (/(

gin.(l -(n (le+gi4 Ti-(, (-( +i5(0(/ ,eel(,((n *)e+(si (/( u)un -i+(5(/ -i +um(hu)un -i+(5(/ -i +um(h s(,i/ sebelumn0(4

s(,i/ sebelumn0(4

4

4 RiRi5(05(0(/ Pe(/ Pen0n0(,i(,i/ Kel/ Kelu(u(+g+g(( P(sien men0(ng

P(sien men0(ng,(l ,(l (-(n0(-(n0( ( +i5(0+i5(0(/ (/ DM -(+(h DM -(+(h /ingg/inggi i s/+*,es/+*,e  )en0)en0(,i/(,i/ .(n/ung gin.(l -(n (le+gi )(-( ,elu(+g

.(n/ung gin.(l -(n (le+gi )(-( ,elu(+g(n0(4(n0(4

D4

D4 RiRi5(05(0(/ (/ PePengng*b*b(/(/(n(n

•

• A(+b*seA(+b*se

III.

III. P%m%P%m%risrisaan aan Fisi Fisi

Dil(,u,(n -i Ru(ng Pe+(5(/(n Umum l(n/(i

(8)

A

A KKee((--((((n n UUmmuumm : T: T((mm))((, , ss((,,ii/ / ssee--((nngg $

$ KKeess((--((++((nn : : **mm))**s s mmeenn//iiss Glasgow Coma Scale

Glasgow Coma Scale : "? 9E@ M6 &?;: "? 9E@ M6 &?; 

 TT((n-n-((TT((n-n-( ( &&ii/(/(ll

−

− Te,(n(n -(+(hTe,(n(n -(+(h : "3!=! mm: "3!=! mm#g#g −

− N(-i N(-i :  C=meni/:  C=meni/ −

− PPee++nn((88((ss((nn : : ""  CC==mmeennii// −

− uuhhuu : : 3366**

D

D D(D(/( /( AAn/n/**))*m*me/e/+i+i

− − $$ee++((/ / bb((--((nn : : 11? ? ,,gg − − TTiingnggi gi b(b(-(-(nn : ": "63 63 mm − − IIMMTT : : 222233 E

E //(/(/uus s GGeennee++((lliiss

−

− Ke)(l(Ke)(l( •

• $$eenn//uu,, : : NN**++mm**ee))hh((ll •

• RR((mmbbuu// : : ##ii//((mm  --iiss//++iibbuussi i mmee++((//((  //ii--((, , mmuu--((h h --ii((bbuu// •

• iimmee//++i i mmuu,,(( : : iimmee//++iiss −

− M(/(M(/( •

• PP((ll))eebb++(( : : EE--eemm( ( == •

• KK**nn..uunngg//ii<<(( : : PPuu((/ / == •

• ,,llee++(( : : II,,//ee++ii, , == •

• KK**++nnee(( : : ''ee++nniihh •

• PPuu))iill : $: $uull((//  IIss**,,**++  RRee88llee, , ((hh((00( ( ll((nnggssuunng g ==  --((nn

/i-(, l(ngsung = /i-(, l(ngsung =

•

• AA++uus s sseenniilliiss : : AA--( ( == •

• LLeennss(( : : NN**++mm((ll  KKee++uuh h == •

• &&iissuuss : : TTii--((, , --ii))ee++ii,,ss(( •

• GGee++((,,((n bn b**ll( m( m((//(( : N: N**++mm((l ,l ,e se seegg((ll( (( (++((hh •

• TTee,,((nn((n bn b**ll( m( m((//(( : N: N**++mm((l )l )ee++))((ll))((ssii − − Teling(Teling( • • $$eenn//uu,, : : NN**++mm((ll • • LLii((nngg : : LL(())((nngg • • ee++uummeenn : : == • • MMuu,,**ss(( : : NN**++mm((ll •

• eell(())uu/ )/ )eenn--eenngg(+(+((nn : I: Inn//(,(, •

• G(nggu(n )en-eng(+(n G(nggu(n )en-eng(+(n : Ti: Ti-(, (-(-(, (-( −

(9)

•

• $$eenn//uu,, : : NN**++mm((ll •

• De<i(si De<i(si e)/um e)/um : : –– •

• ee,,++ee// : : == •

• **nnhh(( : #: #ii))ee++//++**88i i ==  hhii))ee++eemmiis s ==  ee--eemm( ( == −

− Mulu/Mulu/ •

• Mu,*s( Mu,*s( : : N*+m(l N*+m(l i(n*sis i(n*sis == •

• T*nsil T*nsil : : N*+m(l N*+m(l T"=T"T"=T" •

• %(+ing %(+ing : : #i)e+emis #i)e+emis == −

− Lehe+Lehe+ •

• ime/+isime/+is •

• Ti-(, /(m)(, )embes(+(n ,elen.(+ /i+*i-Ti-(, /(m)(, )embes(+(n ,elen.(+ /i+*i-•

• Ti-(, (-( -e<i(si /+(,e(Ti-(, (-( -e<i(si /+(,e( •

• Ti-(, /e+(b( )embes(+(n KG$Ti-(, /e+(b( )embes(+(n KG$ • • '&P ?2 m #'&P ?2 m #22OO − − Th*+(,sTh*+(,s • • Pulm* :Pulm* :

II  N N**++mm**hhees/s/ + +ee//+(+(,,si si ==  sesell( i( igg( /( /ii--(, (, mmeleleebb(+ (+ P

P   TTii--((, , --ii))ee++ii,,ss(( P

P   *n*n*+ *+ )()(-( -( ,e,e-u-u( l( l()()(n(ng )g )(+(+u u $($(/(/(s )s )(+(+u hu h(/(/i ni n*+*+m(m(l )l )(-(-( l( linine(e( mi-l<(<iul( -eC/+( I &I

mi-l<(<iul( -eC/+( I &I A

A   u(u(+( +( n(n(8(8(s <s <esesi,i,ulule+ e+ 99==; ; R*R*n,n,hi hi 99==;  ;  7h7heeeeFiFing ng 99==;;

•

• *+ :*+ :

I

I   I,/us I,/us *+-is *+-is /i-(, /i-(, /e+lih(//e+lih(/ P

P   I,/us I,/us *+-is *+-is /e+(b(/e+(b( thrill thrill 9; 9; heaveheave 9; 9; P

P   $(/($(/(s s (/(s (/(s I I III III linline( e( )(+)(+(s/e(s/e+n(l +n(l sinsinis/is/+( +( $(/$(/(s (s ,i+,i+i i I I && line( (Cil( (n/e+i*+ sinis/+( $(/(s ,(n(n I I& line( )(+(s/em(l -eC/+( line( (Cil( (n/e+i*+ sinis/+( $(/(s ,(n(n I I& line( )(+(s/em(l -eC/+( A

A   $un0i $un0i .(n/ung .(n/ung I I -(n -(n II II +egule+ +egule+ G(ll*) G(ll*)   Mu+mu+ Mu+mu+ 

−

− Ab-*menAb-*men

I

I   D(/(+ D(/(+ ()u/ ()u/ me-us( me-us( 9; 9; m(ss( m(ss( 9;9; A

A   $ising $ising usus usus 9; 9; n*+m(ln*+m(l P

P   Tim)(nTim)(ni i )(-( )(-( selu+uh selu+uh l()(ngl()(ng P

P   Din-ing Din-ing )e+u/ )e+u/ su)el su)el /u+g*+ /u+g*+ ,uli/ ,uli/ b(i, b(i, n0e+i n0e+i /e,(n /e,(n 9;4 9;4 #e)(+ #e)(+ -(n-(n lien /i-(, /e+-()(/ )embes(+(n

lien /i-(, /e+-()(/ )embes(+(n

−

− E,s/+emi/(sE,s/+emi/(s •

(10)

•

• 0d%ma 0d%ma 9-:;< 9-:;< tun*ai tun*ai iri = iri = anananan non-pitting non-pitting %d%ma %d%ma )(n(s 9; )(n(s 9;

e+i/em( 9; <(+ises 9; e+i/em( 9; <(+ises 9; • • RT  2 -e/i, RT  2 -e/i, • • E+i/em( 9=;E+i/em( 9=; • • i(n*sis 9=;i(n*sis 9=; I3

I3. . P%m%P%m%risrisaan aan P%nuP%nun(ann(an**

#(sil )eme+i,s((n )enun.(ng sel(m( )e+(5(/(n #(sil )eme+i,s((n )enun.(ng sel(m( )e+(5(/(n

'enis 'enis Peme+i,s((n Peme+i,s((n T T((nngggg((ll NNiill((i i RRuu..uu,,((nn ! !22==!!66==""66 !!33==!!66==""66 !!@@==!!66==""66 !!??==!!66==""66 !!66==!!66==""66 H%mato&o*i H%mato&o*i # #eemm**ggll**bbiinn ""22"" ""33"" gg==--ll # #eemm((//**,,++ii// 3311 @@!!??22 HH E

E++ii//++**ssii// @@33 @@33––66!! ''uu//((==LL L Leeuu,,**ssii// >>4466!! @44@ !!!!""!!44!!!!==LL T+*mb*si/ T+*mb*si/ 22??2244!!!!!! ""??!!44!!!!!! @!!4!!!=L @!!4!!!=L M M&&  !!>>66 88LL M M## 22>> 22113322 ))JJ M M## 3333 33223366 gg==--ll R RDD77 ""2266!! """"?? –– ""@@??HH #i/ung 'enis #i/ung 'enis $ $((ss**88iill !! !!–– ""HH E E**ssiinn**88iill 33 "" –– 33HH $ $((//((nngg @@ 22 –– 66HH  eeggmmeenn 66!! ??!! –– 11!!HH L Liimm88**ssii// 33!! 22!!––@@!!HH M M**nn**ssii// 33 22 –– HH Koa*u&asi Koa*u&asi 7(

7(,/u P+*/+*mbin ,/u P+*/+*mbin 9PT;9PT;

• • K*n/+*lK*n/+*l """"33 """"@@ """"@@ """"22 """"!! -e/i, -e/i, • • P(sienP(sien "!3 "!3 !>"C !>"C "!6 "!6 !>3C !>3C "!3 "!3 !>C !>C "!6 "!6 !>?C !>?C "! "! !>C !>C "!2 – "22 -e/i, "!2 – "22 -e/i, APTT APTT • • K*n/+*lK*n/+*l 33!! 33@@33 3@3@33 33@@22 3333 -e/i, -e/i, • • P(sienP(sien 31 31 "26C "26C 4!,! 4!,! "1?C "1?C 77,2 77,2 "62C "62C 68,> 68,> ,2? ,2? 2#, 2#, "3>C "3>C 2>! – @!2 -e/i, 2>! – @!2 -e/i, IINNRR !!>>!! !! –– ""33!! %

%iibb++iinn**ggeenn 22>>?? ""3366 –– 33@@ mmgg==--LL D D--iimmee++ 33!!!! ""@@@@ !! –– @@!!!! nngg==mmLL Koa*u&asi Koa*u&asi P PTT !!11==!!66==""66 !!==!!66==""66 !!>>==!!66==""66

(11)

• • K*n/+*lK*n/+*l """""" """"!! """"33 -e/i, -e/i, • • P(sienP(sien "!@ "!@ !>3C !>3C "!3 "!3 !>3C !>3C "!3 "!3 !>"C !>"C "!2 – "22 -e/i, "!2 – "22 -e/i, APTT APTT • • K*n/+*lK*n/+*l 333322 3@3@11 3366@@ -e/i, -e/i, • • P(sienP(sien #",> #",> ,"4? ,"4? 4!,! 4!,! ,26? ,26? 48," 48," ",#8? ",#8? 2>! – @!2 -e/i, 2>! – @!2 -e/i, Kimia K&ini Kimia K&ini 

GGOOTT99AATT;; 3333  33?? UU==LL  GGPPTT99AALLTT;; 22  @@!! UU==LL U U++eeuumm 2211 22!! –– ??!! mmgg==--LL K K++ee((//iinniinn !! !!?? –– ""?? mmgg==--LL G Guull( ( DD((++((hh 9e5(,/u; 9e5(,/u; "2! "2! "1:!6 "1:!6  "@! mg=-L  "@! mg=-L Urina&isis Urina&isis 7 7((++nn(( KKuunniinngg KKuunniinngg K

Kee..ee++nniihh((nn ''ee++nniihh ''ee++nniihh $

$ee++((// ''eenniiss ""44!!""?? "!" !""!! –– ""!!33!! )#

)# 6!6! @6 – !@6 – !

P

P++**//eeiinn ==NNeegg((//ii88 NNeegg((//ii88 G

Glluu,,**ss(( ==NNeegg((//ii88 NNeegg((//ii88 $

$iillii++uubbiinn ==NNeegg((//ii88 NNeegg((//ii88 Ni/+i/

Ni/+i/ =Neg(/i8=Neg(/i8 Neg(/i8 Neg(/i8 K

Kee//**nn ==NNeegg((//ii88 NNeegg((//ii88 U

U++**bbiilliinn**ggeenn !!"" !"! " –– ""!! mmgg==--LL D

D((++((hh ==NNeegg((//ii88 NNeegg((//ii88 Leu,*si/

Leu,*si/ Es/e+(se Es/e+(se

==NNeegg((//ii88 NNeegg((//ii88

e-imen U+in e-imen U+in E E++ii//++**ssii// !!!!!!  22 ==LLPP$$ L Leeuu,,**ssii// ""!!"" ?? ==LLPP$$ 

iilliinn--ee++ ==NNeegg((//ii88 NNeegg((//ii8 8 ==LLPPK K K

K++iiss//((ll ==NNeegg((//ii88 NNeegg((//ii88 E E))ii//eell ==PP**ssii//ii8 8 " " P*si/i8 P*si/i8 L

L((iin n   ll((iinn ==NNeegg((//ii8 8

5-ray %nu 1i&at%ra& 9!:!4:"4< 5-ray %nu 1i&at%ra& 9!:!4:"4< #(sil :

#(sil :

•

• Ke-u-u,(n /ul(ng/ul(ng genu b(i,4Ke-u-u,(n /ul(ng/ul(ng genu b(i,4 •

• Ti-(, /(m)(, sublu,s(si m(u)un -isl*,(si4Ti-(, /(m)(, sublu,s(si m(u)un -isl*,(si4 •

(12)

•

• Densi/(s /ul(ng b(i,4Densi/(s /ul(ng b(i,4 •

• T(m)(, *s/e*8i/ -i *n-0lus me-i(l -(n l(/e+(l 8emu+ bil(/e+(l -(n *n-0lusT(m)(, *s/e*8i/ -i *n-0lus me-i(l -(n l(/e+(l 8emu+ bil(/e+(l -(n *n-0lus

)+*,sim(l

)+*,sim(l me-i(l me-i(l -(n -(n l(/e+(l l(/e+(l *s *s /ibi( /ibi( bil(/e+(l bil(/e+(l b(sis b(sis -(n -(n ()e,s ()e,s )(/ell()(/ell( bil(/e+(l4

bil(/e+(l4

•

• T(T(m)(, en/hes*8i/ -i eminen/i( m)(, en/hes*8i/ -i eminen/i( in/e+*n-0l(+is bil(/e+(l4in/e+*n-0l(+is bil(/e+(l4 •

• el(h sen-i 8em*+*/ibi( men0em)i/ -ise+/(i s,le+*/i, /ibi(l )l(/eu sisi me-i(lel(h sen-i 8em*+*/ibi( men0em)i/ -ise+/(i s,le+*/i, /ibi(l )l(/eu sisi me-i(l •

• T(T(m)(, *ssi8i,(si -i m)(, *ssi8i,(si -i su)+()(/ell(+4su)+()(/ell(+4

Kes(n : OA Genu bil(/e+(l g+(-e

Kes(n : OA Genu bil(/e+(l g+(-e III -eng(n sus)e, s0n*<i/is *s/e*h*n-+*m(/*s(III -eng(n sus)e, s0n*<i/is *s/e*h*n-+*m(/*s(

5-ray @ruris 1i&at%ra& 9!:!4:"4< 5-ray @ruris 1i&at%ra& 9!:!4:"4< #(sil :

#(sil :

•

• Ke-u-u,(n /ul(ng/ul(ng +u+is b(i, /i-(, /(m)(, sublu,s(si -isl*,(si4Ke-u-u,(n /ul(ng/ul(ng +u+is b(i, /i-(, /(m)(, sublu,s(si -isl*,(si4 •

• Ti-(, /(m)(, /(n-(/(n-( 8+(,/u+ -es/+u,si lesi li/i, = bl(s/i,4Ti-(, /(m)(, /(n-(/(n-( 8+(,/u+ -es/+u,si lesi li/i, = bl(s/i,4 •

• Densi/(s /ul(ng b(i,4Densi/(s /ul(ng b(i,4 •

• Ti-(, /(m)(, )emben/u,(n s)u+4Ti-(, /(m)(, )emben/u,(n s)u+4 •

• el(h sen-i -(n )e+mu,((n sen-i 8em*+*/ibi(l (/(u)un sen-i /(l*+u+(l b(i,4el(h sen-i -(n )e+mu,((n sen-i 8em*+*/ibi(l (/(u)un sen-i /(l*+u+(l b(i,4 •

• T(m)(, ,(lsi8i,(si <(sule+ -i sisi )*s/e+i*+ +u+is ,(n(n4T(m)(, ,(lsi8i,(si <(sule+ -i sisi )*s/e+i*+ +u+is ,(n(n4

Kes(n : ,(lsi8i,(si <(sule+ -i sisi )*s/e+i*+ +u+is ,(n(n /ul(ng +u+is ,i+i in/(,4 Kes(n : ,(lsi8i,(si <(sule+ -i sisi )*s/e+i*+ +u+is ,(n(n /ul(ng +u+is ,i+i in/(,4

US Dopp&%r $un*ai Kiri 9!>:!4:"4< US Dopp&%r $un*ai Kiri 9!>:!4:"4< #(sil :

#(sil :

•

• Ku/is -(n sub,u/is meneb(l -eng(n h0)*-e+mis e-em( mul(i +egi* (n,leKu/is -(n sub,u/is meneb(l -eng(n h0)*-e+mis e-em( mul(i +egi* (n,le

s(m)(i -*+s(lis )e-is ,i+i s(m)(i -*+s(lis )e-is ,i+i

•

• &e&en( 8em*+(lis n( 8em*+(lis -(n <en( )*)li/e( -(n <en( )*)li/e( ::

o

o K(libe+ -(l(m b(/(s n*+m(lK(libe+ -(l(m b(/(s n*+m(l o

o &(sul(+ 8l*5 9;&(sul(+ 8l*5 9; o

o *m)le/el0 *m)+ess(ble*m)le/el0 *m)+ess(ble

•

• P(-( <(ls(<( m(neu<e+ /(m)(, +e8luC 0(ng /e+lih(/ P(-( <(ls(<( m(neu<e+ /(m)(, +e8luC 0(ng /e+lih(/ )(-( <4 8em*+(l)(-( <4 8em*+(lis 0(ngis 0(ng

/e+lih(/ )(-( s)e/+(l D*))le+4 /e+lih(/ )(-( s)e/+(l D*))le+4

•

• P(P(-( -( (u(ugmgmenen/(s/(si i /(m/(m)()(, , g(g(mbmb(+((+(n n +e+e8l8luC uC 0(0(ng ng /e/e+li+lih(h(/ / )()(-( -( s)s)e/e/+(l+(l

D*))le+4 D*))le+4 #(sil :

#(sil :

•

• Insu8isiensi h+*ni <4 8em*+(lis su)e+i*+ ,i+i4Insu8isiensi h+*ni <4 8em*+(lis su)e+i*+ ,i+i4 •

• L0L0m)he-em( mul(i +egi* (n,le m)he-em( mul(i +egi* (n,le s(m)(i -*+s(lis )e-is s(m)(i -*+s(lis )e-is ,i+i4,i+i4 •

(13)

3

3. . RR%%ssuumm%% P(s

P(sien ien 5(n5(ni/( i/( be+be+usiusi( ( 6" 6" /(h/(hun un -(/-(/(ng (ng -en-eng(n g(n ,el,eluh(uh(n n benbeng,(g,(, , )(-)(-(( /ung,(i ,i+i se.(, 3 bul(n l(lu -(n membe+(/ se.(, 2 bul(n l(lu4 $eng,(, )(-( /ung,(i ,i+i se.(, 3 bul(n l(lu -(n membe+(/ se.(, 2 bul(n l(lu4 $eng,(, )(-( )unggung ,(,i hingg( lu/u/ ,i+

)unggung ,(,i hingg( lu/u/ ,i+i4 Tung,(i ,(n(n n*+m(l4 em(,in besi4 Tung,(i ,(n(n n*+m(l4 em(,in bes(+ )e+l(h(n4(+ )e+l(h(n4 $e+/(mb(h s((/ be+.(l(n -(n n0e+i4 N0e+i sen-i lu/u/ se.(, " /(hun l(lu sehingg( $e+/(mb(h s((/ be+.(l(n -(n n0e+i4 N0e+i sen-i lu/u/ se.(, " /(hun l(lu sehingg( (,

(,/i</i<i/i/(s (s )()(sisien en bebe+,+,u+u+(n(ng4 g4 KeKeluluh(h(n n se+se+u)u)( ( 6 6 bubul(n l(n l(l(lulu  UUG G : : g(g(ngnggugu(n(n )embuluh

)embuluh -(+(h -(+(h /i-(, /i-(, (-( (-( sumb(/(n4 sumb(/(n4 DM DM se.(, se.(, "6 "6 /(hun /(hun l(lu l(lu gul( gul( -(+(h-(+(h /e+,*n/+*l *b(/ minum4 P(-( )eme+i,s((n 8isi, -i-()(/,(n )(sien *m)*s men/is /e+,*n/+*l *b(/ minum4 P(-( )eme+i,s((n 8isi, -i-()(/,(n )(sien *m)*s men/is hem*-in(mi, s/(bil4 E-em( 9=; /ung,(i ,i+i  ,(n(n

hem*-in(mi, s/(bil4 E-em( 9=; /ung,(i ,i+i  ,(n(n non-pitting non-pitting e-em( )(n(s e-em( )(n(s 9; e+i/em( 9; <(+ises 9;4 L(b 9)+ehe)(+inis(si;  PT !>"C = APTT "26C = INR 9; e+i/em( 9; <(+ises 9;4 L(b 9)+ehe)(+inis(si;  PT !>"C = APTT "26C = INR !>! = %ib+in*gen 2>? = D-ime+ 3!!4 GD "@!4 UG D*))le+ /ung,(i ,i+i 9)*s/ !>! = %ib+in*gen 2>? = D-ime+ 3!!4 GD "@!4 UG D*))le+ /ung,(i ,i+i 9)*s/ he)(+inis(si; : insu8isiensi ,+*ni, <4 8em*+(lis su)e+i*+ ,i+i l0m)he-em( mul(i he)(+inis(si; : insu8isiensi ,+*ni, <4 8em*+(lis su)e+i*+ ,i+i l0m)he-em( mul(i +egi* (n,le s(m)(i -*+s(lis )e-is ,i+i /i-(, /(m)(, D&T4 B+(0 genu bil(/e+(l : +egi* (n,le s(m)(i -*+s(lis )e-is ,i+i /i-(, /(m)(, D&T4 B+(0 genu bil(/e+(l : OA genu bil(/e+(l g+(-e III4

OA genu bil(/e+(l g+(-e III4

3I.

3I. DaDa/ta/tar r MaMasa&sa&a'a' "4

"4 E-E-emem( /( /unung,g,(i (i ,i,i+i+i 24

24 Os/Os/e*e*(+/(+/+i/+i/is geis genu sinu sininis/+s/+(( 34

34 Di(be/eDi(be/es mells melli/us i/us /i)e /i)e 2 g2 gul( ul( -(+(h -(+(h -(l(m -(l(m +egul+egul(si O#(si O#OO

3II.

3II. Dia*nosis Dia*nosis K%r(aK%r(a "4

"4 Chronic Venous InsufficiencyChronic Venous Insufficiency -eng(n -eng(n Deep V Deep Vein Tein Thrombohrombosissis 24

24 Os/eOs/e*(+*(+/+i//+i/is gis genu enu bilbil(/e+(/e+(l g(l g+(-+(-e IIIe III 34

34 Di(be/eDi(be/es mells melli/us i/us /i)e /i)e 2 g2 gul( ul( -(+(h -(+(h -(l(m -(l(m +egul+egul(si O#(si O#OO

3III. P%nata&asanaan 3III. P%nata&asanaan

A

A N*N*nnmme-e-i,i,( m( menen/*/*s(s(

−

− Die/ DM ">!! ,(l*+iDie/ DM ">!! ,(l*+i −

− K*m)+esi /ung,(i ,i+i b(5(h -eng(n s/*,ing = )e+b(n el(s/isK*m)+esi /ung,(i ,i+i b(5(h -eng(n s/*,ing = )e+b(n el(s/is −

− Ku+<( gul( -(+(h h(+i(n 9KGD#;Ku+<( gul( -(+(h h(+i(n 9KGD#;

E

E44 MeMe-i-i,,( m( menen/*/*s(s(

−

− I&%D he)(+in 2!4!!! Uni/ = 2@ I&%D he)(+in 2!4!!! Uni/ = 2@ .(m 9e, APTT = h(+i;.(m 9e, APTT = h(+i; −

− P(+(e/(m*l /(b 3 C ?!! mg PO ,(l(u )e+lu n0e+i = -em(mP(+(e/(m*l /(b 3 C ?!! mg PO ,(l(u )e+lu n0e+i = -em(m −

− A(+b*se /(b 2 C ?! mg /(bA(+b*se /(b 2 C ?! mg /(b −

(14)

I5.

I5. PrPro*no*nosiosiss 

uu* * ((- - <<ii//((mm : : ((- - bb**nn((mm u

u* (* (- 8- 8unun//i*i*n(n(mm : -: -ububi( i( (- (- b*b*n(n(mm u

u* (* (- s- s(n(n(/(/i*i*n(n(mm : -: -ububi( i( (- (- b*b*n(n(mm

5.

5. $i$indnda a LaLan(n(utut $an**a&

$an**a& Follow UpFollow Up $%rapi$%rapi !3=!6="6 !3=!6="6 #(+i #(+i )e+(5(/(n )e+(5(/(n ,e2 ,e2

 : Keluh(n n0e+i )(-( /ung,(i 9; ,i+i  : Keluh(n n0e+i )(-( /ung,(i 9; ,i+i  ,(n(n -em(m 9;4  ,(n(n -em(m 9;4 O : *m)*s men/is O : *m)*s men/is Te Te,(n(n -(+(h ,(n(n -(+(h : : "3!=! "3!=! mm#gmm#g %+e,uensi n(-i : 2C=mn/ %+e,uensi n(-i : 2C=mn/ %+e,uensi n(8(s : " C=mn/ %+e,uensi n(8(s : " C=mn/ uhu : 36? uhu : 36?!!__

M(/( : ,*n.ung/i<( (nemis = s,le+( M(/( : ,*n.ung/i<( (nemis = s,le+( i,/e+i, =

i,/e+i, =

Lehe+: '&P ?2 m# Lehe+: '&P ?2 m#22!! '(n/ung : " 2 n*+m(l +

'(n/ung : " 2 n*+m(l +egule+egule+ mu+mu+ 9; g(ll*) 9;

mu+mu+ 9; g(ll*) 9;

P(+u : <esi,ule+ = +*n,hi = P(+u : <esi,ule+ = +*n,hi = 5heeFing =

5heeFing =

Ab-*men : buni/ lem(s $U n*+m(l Ab-*men : buni/ lem(s $U n*+m(l E,s/+emi/(s : e-em( /ung,(i ,i+i  E,s/+emi/(s : e-em( /ung,(i ,i+i  ,(n(n

,(n(n non-pitting non-pitting  n0e+i /e,(n = n0e+i /e,(n = e+i/em( =

e+i/em( =

#(sil )eme+i,s((n )enun.(ng -i sub #(sil )eme+i,s((n )enun.(ng -i sub b(b )eme+i,s((n )enun.(ng4 b(b )eme+i,s((n )enun.(ng4 A : A : Ren(n( Di(gn*s/i, : Ren(n( Di(gn*s/i, : −

− e, APTT=h(+ie, APTT=h(+i −

− KGD#KGD# −

− K*nsul/(si +eh(b me-i, K*nsul/(si +eh(b me-i,

Ren(n( Te+()i : Ren(n( Te+()i :

−

− I&%D he)(+in 2!4!!!I&%D he)(+in 2!4!!!

U=2@.(m U=2@.(m − − P(+(e/(m*l /(b 3C?!!mgP(+(e/(m*l /(b 3C?!!mg PO )+n n0e+i=-em(m PO )+n n0e+i=-em(m − − A(+b*se 2C?!mg POA(+b*se 2C?!mg PO −

− Pi+*Ci(m *in/ /ube 9lu/u/;Pi+*Ci(m *in/ /ube 9lu/u/;

)+n n0e+i )+n n0e+i

(15)

"4

"4 &&I -eI -engng(n D(n D&T &T /u/ungng,(,(i ,ii ,i+i+i 24

24 OA OA gegenunus bis bil(/l(/e+(e+(l g+(l g+(-e II-e IIII 34 34 DDMTMT22 G GD *D *n On O##OO !@=!6="6 !@=!6="6 #(+i #(+i )e+(5(/(n )e+(5(/(n ,e3 ,e3

 : Keluh(n n0e+i )(-( /ung,(i 9; ,i+i  : Keluh(n n0e+i )(-( /ung,(i 9; ,i+i  ,(n(n -em(m 9;4  ,(n(n -em(m 9;4 O : *m)*s men/is O : *m)*s men/is Te Te,(n(n -(+(h ,(n(n -(+(h : : "3!=! "3!=! mm#gmm#g %+e,uensi n(-i : 2C=mn/ %+e,uensi n(-i : 2C=mn/ %+e,uensi n(8(s : " C=mn/ %+e,uensi n(8(s : " C=mn/ uhu : 36? uhu : 36?!!__

i,/e+i, =

mu+mu+ 9; g(ll*) 9;

5heeFing =

e+i/em( =

#(sil )eme+i,s((n )enun.(ng -i sub #(sil )eme+i,s((n )enun.(ng -i sub b(b )eme+i,s((n )enun.(ng4

b(b )eme+i,s((n )enun.(ng4

A : A : "4

"4 &&I -eI -engng(n D(n D&T &T /u/ungng,(,(i ,ii ,i+i+i 24

24 OA OA gegenunus bis bil(/l(/e+(e+(l g+(l g+(-e II-e IIII 34

34 DDMTMT22 G GD *D *n On O##OO

Ren(n( Di(gn*s/i, : Ren(n( Di(gn*s/i, :

−

− e, APTT=h(+ie, APTT=h(+i

−

− I&%D he)(+in 2!4!!!I&%D he)(+in 2!4!!!

U=2@.(m U=2@.(m − − P(+(e/(m*l /(b 3C?!!mgP(+(e/(m*l /(b 3C?!!mg PO )+n n0e+i=-em(m PO )+n n0e+i=-em(m − − A(+b*se 2C?!mg POA(+b*se 2C?!mg PO −

)+n n0e+i )+n n0e+i !?=!6="6 !?=!6="6 #(+i #(+i )e+(5(/(n )e+(5(/(n

 : Keluh(n n0e+i lu/u/ 9; /e+u/(m(  : Keluh(n n0e+i lu/u/ 9; /e+u/(m( ,i+i beng,(, )(-( /ung,(i 9;4 ,i+i beng,(, )(-( /ung,(i 9;4

−

(16)

,

,ee@@ O O : : **mm))**s s mmeenn//iiss Te Te,(n(n -(+(h ,(n(n -(+(h : : "3!=1! "3!=1! mm#gmm#g %+e,uensi n(-i : 1C=mn/ %+e,uensi n(-i : 1C=mn/ %+e,uensi n(8(s : 2! C=mn/ %+e,uensi n(8(s : 2! C=mn/ uhu : 36? uhu : 36?!!__

i,/e+i, =

mu+mu+ 9; g(ll*) 9;

5heeFing =

e+i/em( =

A : A : "4

"4 &&I -enI -eng(g(n D&n D&T 9)T 9)e+be+b(i(i,(,(n;n; 24

24 OA OA gegenunus bis bil(/l(/e+(e+(l g+(l g+(-e II-e IIII 34

−

− I&%D he)(+in 2!4!!!I&%D he)(+in 2!4!!!

U=2@.(m 92=.(m; U=2@.(m 92=.(m; − − P(+(e/(m*l /(b 3C?!!mgP(+(e/(m*l /(b 3C?!!mg PO )+n n0e+i=-em(m PO )+n n0e+i=-em(m − − A(+b*se 2C?!mg POA(+b*se 2C?!mg PO −

)+n n0e+i )+n n0e+i !6=!6="6 !6=!6="6 #(+i #(+i )e+(5(/(n )e+(5(/(n ,e? ,e?

 : Keluh(n n0e+i lu/u/ 9; /e+u/(m(  : Keluh(n n0e+i lu/u/ 9; /e+u/(m( ,i+i beng,(, )(-( /ung,(i 9;4 ,i+i beng,(, )(-( /ung,(i 9;4

O : *m)*s men/is O : *m)*s men/is Te Te,(n(n -(+(h ,(n(n -(+(h : : "3!=1! "3!=1! mm#gmm#g %+e,uensi n(-i : 1C=mn/ %+e,uensi n(-i : 1C=mn/ %+e,uensi n(8(s : 2! C=mn/ %+e,uensi n(8(s : 2! C=mn/ uhu : 36? uhu : 36?!!__ Ren(n( Di(gn*s/i, : Ren(n( Di(gn*s/i, : −

− e, PT -(n APTTe, PT -(n APTT −

− e, D-ime+ e, D-ime+

−

− I&%D he)(+in 2!4!!!I&%D he)(+in 2!4!!!

U=2@.(m 92=.(m; U=2@.(m 92=.(m;

−

(17)

i,/e+i, =

mu+mu+ 9; g(ll*) 9;

5heeFing =

e+i/em( =

A : A : "4

"4 &&I -enI -eng(g(n D&n D&T 9)T 9)e+be+b(i(i,(,(n;n; 24

24 OA OA gegenunus bis bil(/l(/e+(e+(l g+(l g+(-e II-e IIII DMT2 GD *n O#O DMT2 GD *n O#O PO )+n n0e+i=-em(m PO )+n n0e+i=-em(m − − T+(m(-*l 3 C ?! mg PO )+nT+(m(-*l 3 C ?! mg PO )+n n0e+i n0e+i − − A(+b*se 2C?!mg POA(+b*se 2C?!mg PO −

)+n n0e+i )+n n0e+i !1=!6="6 !1=!6="6 #(+i #(+i )e+(5(/(n )e+(5(/(n ,e6 ,e6

 : Keluh(n 9; beng,(, /ung,(i 9;  : Keluh(n 9; beng,(, /ung,(i 9; n0e+i /ung,(i 9; lu/u/ m(sih suli/ n0e+i /ung,(i 9; lu/u/ m(sih suli/ -ige+(,,(n -ige+(,,(n O : *m)*s men/is O : *m)*s men/is Te Te,(n(n -(+(h ,(n(n -(+(h : : "3!=! "3!=! mm#gmm#g %+e,uensi n(-i : 1!C=mn/ %+e,uensi n(-i : 1!C=mn/ %+e,uensi n(8(s : 2!C=mn/ %+e,uensi n(8(s : 2!C=mn/ uhu : 36? uhu : 36?!!__

M(/( : ,*n.ung/i<( (nemis = s,le+( M(/( : ,*n.ung/i<( (nemis = s,le+( i,/e+i, = i,/e+i, = Lehe+: '&P ?2 m# Lehe+: '&P ?2 m#22!! Ren(n( Di(gn*s/i, : Ren(n( Di(gn*s/i, : −

− e, APTT -(n INR 9/(+ge/e, APTT -(n INR 9/(+ge/

APTT "?2?C INR 23; APTT "?2?C INR 23;

−

− I&%D he)(+in 2!4!!!I&%D he)(+in 2!4!!!

U=2@.(m U=2@.(m − − P(+(e/(m*l /(b 3C?!!mgP(+(e/(m*l /(b 3C?!!mg PO )+n n0e+i=-em(m PO )+n n0e+i=-em(m − − T+(m(-*l 3 C ?! mg PO )+nT+(m(-*l 3 C ?! mg PO )+n n0e+i n0e+i − − A(+b*se 2C?!mg POA(+b*se 2C?!mg PO −

)+n n0e+i )+n n0e+i

(18)

'(n/ung : " 2 n*+m(l +

mu+mu+ 9; g(ll*) 9;

5heeFing =

e+i/em( =

A : A : "4

"4 &I &I -en-eng(n g(n D&T D&T 9)e9)e+b(+b(i,(i,(n –n – APTT /e+()(i;

APTT /e+()(i; 24

24 OA OA gegenunus bis bil(/l(/e+(e+(l g+(l g+(-e II-e IIII 34 34 DDMTMT22 G GD *D *n On O##OO !=!6="6 !=!6="6 #(+i #(+i )e+(5(/(n )e+(5(/(n ,e1 ,e1

 : Keluh(n n0e+i /ung,(i 9; beng,(,  : Keluh(n n0e+i /ung,(i 9; beng,(, ,i+i  ,(n(n ,i+i  ,(n(n O : *m)*s men/is O : *m)*s men/is Te Te,(n(n -(+(h ,(n(n -(+(h : : "3!=! "3!=! mm#gmm#g %+e,uensi n(-i : 12C=mn/ %+e,uensi n(-i : 12C=mn/ %+e,uensi n(8(s : 2!C=mn/ %+e,uensi n(8(s : 2!C=mn/ uhu : 36? uhu : 36?!!__

i,/e+i, =

mu+mu+ 9; g(ll*) 9;

5heeFing =

−

APTT "?2?C INR 23; APTT "?2?C INR 23;

−

− I&%D he)(+in 2!4!!!I&%D he)(+in 2!4!!!

U=2@.(m U=2@.(m

−

− im(+ "C2mgPOim(+ "C2mgPO − − P(+(e/(m*l /(b 3C?!!mgP(+(e/(m*l /(b 3C?!!mg PO )+n n0e+i=-em(m PO )+n n0e+i=-em(m − − T+(m(-*l 3 C ?! mg PO )+nT+(m(-*l 3 C ?! mg PO )+n n0e+i n0e+i − − A(+b*se 2C?!mg POA(+b*se 2C?!mg PO −

)+n n0e+i )+n n0e+i

(19)

e+i/em( =

A : A : "4

"4 &I &I -en-eng(n g(n D&T D&T 9)e9)e+b(+b(i,(i,(n –n – APTT 2"C PT !>C;

APTT 2"C PT !>C; 24

24 OA OA gegenunus bis bil(/l(/e+(e+(l g+(l g+(-e II-e IIII 34 34 DDMTMT22 G GD *D *n On O##OO !>=!6="6 !>=!6="6 #(+i #(+i )e+(5(/(n )e+(5(/(n ,e ,e

 : Keluh(n s((/ ini 9; beng,(, ,i+i   : Keluh(n s((/ ini 9; beng,(, ,i+i  ,(n(n ,(n(n O : *m)*s men/is O : *m)*s men/is Te Te,(n(n -(+(h ,(n(n -(+(h : : "3!=! "3!=! mm#gmm#g %+e,uensi n(-i : 16C=mn/ %+e,uensi n(-i : 16C=mn/ %+e,uensi n(8(s : 2!C=mn/ %+e,uensi n(8(s : 2!C=mn/ uhu : 36? uhu : 36?!!__

i,/e+i, =

mu+mu+ 9; g(ll*) 9;

5heeFing =

e+i/em( =

−

APTT "?2?C INR 23; APTT "?2?C INR 23; Ren(n( Te+()i : Ren(n( Te+()i : − − R(5(/ .(l(nR(5(/ .(l(n −

− I&%D he)(+in 2!4!!!I&%D he)(+in 2!4!!!

U=2@.(m 9s/*); U=2@.(m 9s/*); − − P(+(e/(m*l /(b 3C?!!mgP(+(e/(m*l /(b 3C?!!mg PO )+n n0e+i=-em(m PO )+n n0e+i=-em(m − − T+(m(-*l 3 C ?! mg PO )+nT+(m(-*l 3 C ?! mg PO )+n n0e+i n0e+i − − A(+b*se 2C?!mg POA(+b*se 2C?!mg PO −

)+n n0e+i )+n n0e+i

(20)

A : A : @4

@4 &I &I -en-eng(n g(n D&T D&T 9)e9)e+b(+b(i,(i,(n –n – APTT 2@C PT !>3C;

APTT 2@C PT !>3C; ?4

?4 OA OA gegenunus bis bil(/l(/e+(e+(l g+(l g+(-e II-e IIII 64

5I.

5I. P%P%n*n*a(ia(ianan "4

"4 Chronic Venous InsufficiencyChronic Venous Insufficiency -eng(n -eng(n Deep V Deep Vein Thein Thrombosisrombosis Di)i,i+,(n &I -eng(n D&T (/(s -(s(+:

Di)i,i+,(n &I -eng(n D&T (/(s -(s(+: An(mnesis

An(mnesis

•

• $eng,(, )(-( /ung,(i ,i+i 93 bul(n; membe+(/ 92 bul(n;4$eng,(, )(-( /ung,(i ,i+i 93 bul(n; membe+(/ 92 bul(n;4 •

• L*,(si : Punggung ,(,i hingg( lu/u/ ,i+i4 Tung,(i ,(n(n n*+m(l4L*,(si : Punggung ,(,i hingg( lu/u/ ,i+i4 Tung,(i ,(n(n n*+m(l4 •

• em(,in l(m( sem(,in bes(+ )+*g+esi )e+l(h(n4 M(,in l(m( beng,(, suli/em(,in l(m( sem(,in bes(+ )+*g+esi )e+l(h(n4 M(,in l(m( beng,(, suli/

be+,u+(ng -(n l(m(,el(m((n mene/()4 be+,u+(ng -(n l(m(,el(m((n mene/()4

•

• $e+/(mb(h s((/ be+-i+i l(m( = be+.(l(n4 $e+,u+(ng s((/ -u-u, -(n men(i,,(n$e+/(mb(h s((/ be+-i+i l(m( = be+.(l(n4 $e+,u+(ng s((/ -u-u, -(n men(i,,(n

/ung,(i4 /ung,(i4

•

• N0e+i s((/ be+.(l(n suli/ be+.(l(n4 N0e+i s((/ be+.(l(n suli/ be+.(l(n4 •

• Ti-(, (-( )e+ub(h(n 5(+n( ,uli/ (/(u)un lu,(4Ti-(, (-( )e+ub(h(n 5(+n( ,uli/ (/(u)un lu,(4 •

• N0e+i sen-i lu/u/ 9" /(hun; sehingg( (,/i<i/(s )(sien be+,u+(ng4 N0e+i sen-i lu/u/ 9" /(hun; sehingg( (,/i<i/(s )(sien be+,u+(ng4 •

• Ri5(0(/ ,eluh(n se+u)( 96 bul(n; su-(h UG : g(nggu(n )embuluh -(+(hRi5(0(/ ,eluh(n se+u)( 96 bul(n; su-(h UG : g(nggu(n )embuluh -(+(h

/i-(, (-( sumb(/(n4 u-(h memb(i, -(n /i-(, minum *b(/4 /i-(, (-( sumb(/(n4 u-(h memb(i, -(n /i-(, minum *b(/4

•

• DM 9"6 /(hun; gul( -(+(h /e+,*n/+*l *b(/ minum4DM 9"6 /(hun; gul( -(+(h /e+,*n/+*l *b(/ minum4

Peme+i,s((n %isi, Peme+i,s((n %isi,

•

• *m)*s men/is hem*-in(mi, s/(bil4*m)*s men/is hem*-in(mi, s/(bil4 •

• '(n/ung -(n )(+u -(l(m b(/(s n*+m(l4'(n/ung -(n )(+u -(l(m b(/(s n*+m(l4 •

• E,E,s/+s/+imimi/(i/(s s : : (,(,+(l +(l h(h(ngng(/(/  e-e-emem( ( 99=; =; /u/ungng,(,(i i ,i,i+i +i   ,(,(n(n(nn non-pitting non-pitting

e-em( )(n(s 9; e+i/em( 9; <(+ises 9; RT  2 -e/i,4 e-em( )(n(s 9; e+i/em( 9; <(+ises 9; RT  2 -e/i,4 Peme+i,s((n Penun.(ng

(21)

•

• L(b 9)+ehe)(+inis(si;  PT !>"C = APTT "26C = INR !>! = %ib+in*gen 2>? =L(b 9)+ehe)(+inis(si;  PT !>"C = APTT "26C = INR !>! = %ib+in*gen 2>? =

D-ime+ 3!! D-ime+ 3!!

•

• UG D*))le+ /ung,(i ,i+i 9)*s/he)(+inis(si; : insu8isiensi ,+*ni, <4 8em*+(lisUG D*))le+ /ung,(i ,i+i 9)*s/he)(+inis(si; : insu8isiensi ,+*ni, <4 8em*+(lis

su)e+i

su)e+i*+ ,i+i *+ ,i+i l0m)l0m)he-em( mul(i +egi* (n,le he-em( mul(i +egi* (n,le s(m)(i -*+s(lis(m)(i -*+s(lis s )e-is ,i+i /i-(, )e-is ,i+i /i-(, /(m)(, D&T4

/(m)(, D&T4 Ru.u,(n Ilmi(h Ru.u,(n Ilmi(h

Kl(si8i,(si EAP un/u, &I : Kl(si8i,(si EAP un/u, &I : 3  e-em(

3  e-em(

Es  se,un-e+ -i)i,i+,(n ,(+en( +i5(0(/ D&T -(n

Es  se,un-e+ -i)i,i+,(n ,(+en( +i5(0(/ D&T -(n s((/ ini be+ul(ngs((/ ini be+ul(ng A-  <en( )+*8un-( 9<4 8em*+(lis su)e+i*+ ,i+i;

A-  <en( )+*8un-( 9<4 8em*+(lis su)e+i*+ ,i+i;

P+  +e8lu,s 9h(sil UG D*))le+ : +e8lu,s 9; *bs/+u,si 9; P+  +e8lu,s 9h(sil UG D*))le+ : +e8lu,s 9; *bs/+u,si 9; Ren(n( Di(gn*s/i,

Ren(n( Di(gn*s/i,

•

• e, APTT=he, APTT=h(+i un/u, e<(lu(si /e(+i un/u, e<(lu(si /e+()i (n/i,*(gul(n+()i (n/i,*(gul(n

Ren(n( Te+()i  T(/(l(,s(n( K*nse+<(/i8 Ren(n( Te+()i  T(/(l(,s(n( K*nse+<(/i8

•

• TeTe+()i ,*m)+esi : )e+b(n +()i ,*m)+esi : )e+b(n el(s/isel(s/is •

• Pe+(5(/(n ,uli/ : .(g( ,elemb()(n ,uli/ 9Pe+(5(/(n ,uli/ : .(g( ,elemb()(n ,uli/ 9moisturizer moisturizer ; .(g( ,ebe+sih(n; .(g( ,ebe+sih(n

Ren(n( E-u,(si Ren(n( E-u,(si

•

• E-u,(si )en0(,i/ 0(ng -i-e+i/( )(sien -(n +en(n( )en(/(l(,s(n((nn0(E-u,(si )en0(,i/ 0(ng -i-e+i/( )(sien -(n +en(n( )en(/(l(,s(n((nn0( •

• K*n/+*l +u/in un/u, e<(lu(si ,linisK*n/+*l +u/in un/u, e<(lu(si ,linis •

• Ol(h+(g( +u/in un/u, memb(n/u mengemb(li,(n 8ungsi Ol(h+(g( +u/in un/u, memb(n/u mengemb(li,(n 8ungsi )*m)( */*/ be/is)*m)( */*/ be/is

24

24 Os/e*(Os/e*(+/+i/is +/+i/is genu genu bil(/ebil(/e+(l g+(+(l g+(-e III-e III

Di)i,i+,(n *s/e*(+/+i/is genu bil(/e+(l g+(-e III (/(s -(s(+: Di)i,i+,(n *s/e*(+/+i/is genu bil(/e+(l g+(-e III (/(s -(s(+: An(mnesis

An(mnesis

•

• N0e+i lu/u/ ,i+i 9" /(hun; /(.(m4 N0e+i lu/u/ ,i+i 9" /(hun; /(.(m4 •

• Timbul s((/ be+.(l(n be+,u+(ng s((/ be+is/i+(h(/4Timbul s((/ be+.(l(n be+,u+(ng s((/ be+is/i+(h(/4 •

• A,/i<i/(s be+,u+(ng ,(+en( n0e+i4A,/i<i/(s be+,u+(ng ,(+en( n0e+i4 •

• u-(h be+*b(/ ,e *+/*)e-i +en(n( *)e+(si n(mun men*l(,4u-(h be+*b(/ ,e *+/*)e-i +en(n( *)e+(si n(mun men*l(,4

/(/us L*,(lis genu sinis/+( : /(/us L*,(lis genu sinis/+( :

•

• oo! oo! : /i-(, (-( /(n-( in8l(m(si : /i-(, (-( /(n-( in8l(m(si •

• "eel "eel : /e+(b( h(ng(/ 9; n0e+i /e,(n 9;: /e+(b( h(ng(/ 9; n0e+i /e,(n 9; •

• #ove #ove : : range of motionrange of motion /i-(, /e+g(nggu /i-(, /e+g(nggu

Peme+i,s((n Penun.(ng Peme+i,s((n Penun.(ng

(22)

B+(0 genu bil(/e+(l : OA genu bil(/e+(l g+(-e III B+(0 genu bil(/e+(l : OA genu bil(/e+(l g+(-e III Ren(n( Di(gn*s/i, Ren(n( Di(gn*s/i, u-(h -il(,u,(n4 u-(h -il(,u,(n4 Ren(n( Te+()i Ren(n( Te+()i •

• K*nsul/(si *+/*)e-i un/u, )en(ng(n(n lebih l(n.u/K*nsul/(si *+/*)e-i un/u, )en(ng(n(n lebih l(n.u/ •

• P(+(e/(m*l /(b 3C?!!mg PO )+n n0e+i=-em(mP(+(e/(m*l /(b 3C?!!mg PO )+n n0e+i=-em(m •

• T+(m(-*l 3 C ?! mg PO )+n n0e+iT+(m(-*l 3 C ?! mg PO )+n n0e+i •

• Pi+*Ci(m *in/ /ube 9lu/u/; )+n n0e+iPi+*Ci(m *in/ /ube 9lu/u/; )+n n0e+i

34

34 Di(be/Di(be/es melli/ues melli/us /i)e 2 gul( -s /i)e 2 gul( -(+(h -(l(m +e(+(h -(l(m +egul(si Ogul(si O#O#O

Di)i,i+,(n Di(be/es melli/us /i)e 2 gul( -(+(h -(l(m +egul(si O#O (/(s -(s(+: Di)i,i+,(n Di(be/es melli/us /i)e 2 gul( -(+(h -(l(m +egul(si O#O (/(s -(s(+: An(mnesis

An(mnesis

•

• DM 9"6 /(hun; ge.(l( ,l(si, 93P;4DM 9"6 /(hun; ge.(l( ,l(si, 93P;4 •

• Gul( -(+(h /inggi s((/ -i)e+i,s(4Gul( -(+(h /inggi s((/ -i)e+i,s(4 •

• Ru/in ,*n/+*l ,e -*,/e+ -(n ,*nsumsi *b(/ 9((+b*se;Ru/in ,*n/+*l ,e -*,/e+ -(n ,*nsumsi *b(/ 9((+b*se; •

• Gul( -(+(h /e+,*n/+*l4Gul( -(+(h /e+,*n/+*l4

•

• *m)*s men/is hem*-in(mi, s/(bil4*m)*s men/is hem*-in(mi, s/(bil4 •

• '(n/ung -(n )(+u -(l(m b(/(s n*+m(l4'(n/ung -(n )(+u -(l(m b(/(s n*+m(l4 •

• Ti-(, (-( lu,(4Ti-(, (-( lu,(4

Peme+i,s((n Penun.(ng Peme+i,s((n Penun.(ng • • GD "@! mg=-LGD "@! mg=-L Ren(n( Di(gn*s/i, Ren(n( Di(gn*s/i, •

• Ku+<( gul( -(+(h h(+i(nKu+<( gul( -(+(h h(+i(n

Ren(n( Te+()i Ren(n( Te+()i

•

(23)

1A1 III 1A1 III

$INAUAN PUS$AKA $INAUAN PUS$AKA

I

I AnAnatatomomi i dadan n FiFisisio&o&o*o*i i 33%%nana

is/em <en( )e+i8e+ be+8ungsi seb(g(i +ese+<*(+ -(+(h -(n seb(g(i s(lu+(n is/em <en( )e+i8e+ be+8ungsi seb(g(i +ese+<*(+ -(+(h -(n seb(g(i s(lu+(n un

un/u/u, , memengngememb(b(li,li,(n (n -(-(+(h +(h ,e ,e .(.(n/n/unung4 g4 $e$e+8u+8ungngsinsin0( 0( sissis/e/em m <e<en( n( )e)e+i+i8e+ 8e+ be+g(n/ung )(-(

be+g(n/ung )(-( )(/ensi )(/ensi )embuluh )embuluh 0(ng 0(ng memili,i memili,i se+(ng,(i(nse+(ng,(i(n $-way valves$-way valves -(n-(n )*m)(

)*m)( */*/4 */*/4 D(l(m D(l(m )*sisi )*sisi /eg(, /eg(, -(+(h -(+(h mem(su,i mem(su,i sis/em sis/em <en( <en( e,s/+imi/(s e,s/+imi/(s b(5(hb(5(h -(n h(+us be+.(l(n mel(5(n g+(<i/(si -(n /e,(n(n l(in un/u, ,emb(li ,e si+,ul(si -(n h(+us be+.(l(n mel(5(n g+(<i/(si -(n /e,(n(n l(in un/u, ,emb(li ,e si+,ul(si sen/+(l 9

sen/+(l 9"";4;4

&en( e,s/+imi/(s b(5(h /e+b(gi men.(-i <en( su)e+8isi(l )+*8un-( -(n &en( e,s/+imi/(s b(5(h /e+b(gi men.(-i <en( su)e+8isi(l )+*8un-( -(n perforator

perforator 9922;4 is/em <en( su)e+8isis(l /e+le/(, -i (/(s l()is(n 8(si( mus,ul(+is;4 is/em <en( su)e+8isis(l /e+le/(, -i (/(s l()is(n 8(si( mus,ul(+is 0(

0(ng ng /e/e+-+-i+i+is is -(-(+i +i .(+.(+ining(g(n n <e<en( n( 0(0(ng ng s(ls(lining g /e/e+h+hububunung g -(-(n n bebebebe+()+()( ( <e<en(n( su)e+8isi(l /+un(l /e+m(su, <en( s()hen( m(gn( =

su)e+8isi(l /+un(l /e+m(su, <en( s()hen( m(gn( = great s great saphenous aphenous veinvein 9G&; 9G&;

--(n (n <<enen( ( s(s()h)henen( ( )()(+<+<( ( == small small saphenous saphenous veinvein  -(-(n n .u.ug( g( bebebebe+(+()( )( <e<en(n( (,s

(,ses*es*+iu+ius s 0(n0(ng g -()-()(/ (/ menmeng(lg(l(mi (mi )(/)(/*l**l*gi gi menmen0un0unb(nb(ng g &I&I4 4 isis/em /em <en<en(( )+*8un-( /e+

)+*8un-( /e+le/(, le/(, -i -i b(5(h b(5(h l()is(n l()is(n 8(si( 8(si( mus,ul(+is mus,ul(+is -(n -(n be+8ungsi be+8ungsi seb(g(i seb(g(i mu(+(mu(+( <en( -(n

<en( -(n outflowoutflow -(+i e,s/+imi/(s b(5(h4 &en( )+*8un-( /e+-i+i -(+i -(+i e,s/+imi/(s b(5(h4 &en( )+*8un-( /e+-i+i -(+i a%ial veinsa%ial veins -im(n( .(lu+n0( mengi,u/i (+/e+i

-im(n( .(lu+n0( mengi,u/i (+/e+i bes(+ -(n <en( in/+(mus,ul(+ /e+m(su, sinus*i-bes(+ -(n <en( in/+(mus,ul(+ /e+m(su, sinus*i--(

-(n n )l)le,e,susus s <e<en(n(44 &erforating &erforating veinsveins menmenembembus us l()l()is(n 8(si( is(n 8(si( (n(/(n(/*mi*mis s un/un/u, u, menghubung,(n sis/em <en( su)e+8isi(l -eng(n )+*8un-( 9

menghubung,(n sis/em <en( su)e+8isi(l -eng(n )+*8un-( 9 "";4;4

K(/u) )(-( <en( )en/ing -(l(m mem(s/i,(n -(+(h meng(li+ ,e (+(h 0(ng K(/u) )(-( <en( )en/ing -(l(m mem(s/i,(n -(+(h meng(li+ ,e (+(h 0(ng /e)(/ /e+u/(m( )(-( )*sisi /eg(, 9

/e)(/ /e+u/(m( )(-( )*sisi /eg(, 922;4 Te+-()(/ se+(ng,(i(n;4 Te+-()(/ se+(ng,(i(n $-way valve$-way valve bi,us)i- bi,us)i- )(-(

)(-( <en( <en( )+*8un-( )+*8un-( -(n -(n su)e+8isi(l su)e+8isi(l 0(ng 0(ng membu,( membu,( un/u, un/u, meng(li+,(n meng(li+,(n -(+(h-(+(h menu.u .(n/ung -(n menu/u) un/u, meneg(h -(+(h ,emb(li ,e ,(,i4 Te+-()(/ @ menu.u .(n/ung -(n menu/u) un/u, meneg(h -(+(h ,emb(li ,e ,(,i4 Te+-()(/ @ 8(se

8(se -(l(-(l(m m 8un8ungsi gsi ,(/,(/u) u) melimeli)u/)u/i i )em)embu,bu,((n ((n e,ue,uilibilib+ium+ium  )en)enu/uu/u)(n)(n  -(n-(n /e+/u/u)4 %(,/*+ )en/ing un/u, 8ungsi ,(/u) (-(l(h (li+(n -(+(h 0(ng membu,( /e+/u/u)4 %(,/*+ )en/ing un/u, 8ungsi ,(/u) (-(l(h (li+(n -(+(h 0(ng membu,( ,(/

,(/u) u) -(n ,ee)-(n ,ee)(/(n <e+/i(/(n <e+/i,(l )(-(,(l )(-( cupcup <en( 0(ng mening,(/,(n /e,(n(n mu+(l <en( 0(ng mening,(/,(n /e,(n(n mu+(l +el(/i8 /e+h(-() /e,(n(n lumen be+u.ung )(-( )enu/u)(n ,(/u) 9

+el(/i8 /e+h(-() /e,(n(n lumen be+u.ung )(-( )enu/u)(n ,(/u) 9 33;4 %+e,uensi;4 %+e,uensi ,(/

,(/u) u) <en<en( ( ini ini menmeninging,(/ ,(/ -(+-(+i i )+*)+*,si,sim(l m(l ,e ,e -is-is/(l /(l /un/ung,(g,(i i un/un/u, u, menmenegeg(h(h )ening,(/(n

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/(mb(h(n

/(mb(h(n perforating perforating veinsveins .ug( memili,i ,(/u) 0(ng h(n0( meng(li+,(n -(+(h .ug( memili,i ,(/u) 0(ng h(n0( meng(li+,(n -(+(h -(+i <en( su)e+8isi(l ,e )+*8un-( 9

-(+i <en( su)e+8isi(l ,e )+*8un-( 9"";4;4

5II.

5II. PatoPato/isio/isio&o*i&o*i P(

P(/*/*l*l*gi gi <e<en( n( /e+/e+.(-.(-i i s((s((/ / /e/e,(,(n(n(n n <e<en( n( menmenining,g,(/ (/ -(-(n n (li(li+(n +(n -(-(+(h+(h /e+g(nggu mel(lui bebe+()( me,(nisme4 #(l ini -()(/ /e+.(-i ,(+en( in,*m)e/ensi /e+g(nggu mel(lui bebe+()( me,(nisme4 #(l ini -()(/ /e+.(-i ,(+en( in,*m)e/ensi ,(/

,(/u) u) -(+-(+i i <en<en( ( )+*)+*8un8un-( -( (/(u su)e+8(/(u su)e+8isi(isi(ll perforator perforator veinsveins )e+(b(ng(n <en( )e+(b(ng(n <en( (/(u *bs/+u,si <en( (/(u ,*mbin(si ,e-u(n0(4 %(,/*+ in

(/(u *bs/+u,si <en( (/(u ,*mbin(si ,e-u(n0(4 %(,/*+ in i -i)e+be+(/ *leh -is8ungsii -i)e+be+(/ *leh -is8ungsi )*m)(

)*m)( */*/ */*/ */*/ */*/ be/is be/is (-(l(h (-(l(h 0(ng 0(ng )(ling )(ling be+-(m)(,4 be+-(m)(,4 Me,(nisme Me,(nisme ini ini men-(s(+imen-(s(+i /e+

/e+.(-i.(-in0( n0( hi)hi)e+/e+/ensensi i <en<en( ( gl*gl*b(l b(l (/(u (/(u +eg+egi*ni*n(l (l /e+u/e+u/(m/(m( ( -en-eng(n g(n be+be+-i+-i+i i (/(u(/(u (mb

(mbul(ul(si4 si4 $e+$e+)e+)e+(n (n -(l-(l(m (m g(ng(ngguggu(n (n hemhem*-i*-in(mn(mi, i, si+si+,ul,ul(si (si m(,m(,+* +* (-((-(l(hl(h )e+ub(h(n

)e+ub(h(n -(l(m -(l(m si+,ul(si si+,ul(si mi,+* mi,+* 99@@;4 ;4 #i)#i)e+/ee+/ensi nsi <en<en( ( be+be+,el,el(n.u(n.u/(n /(n -()-()(/(/ be+u.ung(

be+u.ung( )(-( )(-( )e+ub(h(n )e+ub(h(n ,uli/ ,uli/ men.(-i men.(-i hi)e+)igmen/(si hi)e+)igmen/(si li)*-e+m(/*s,le+*sisli)*-e+m(/*s,le+*sis 98ib+*sis .(+ing(n sub,u/(n; -(n b(h,(n ul,us 9

98ib+*sis .(+ing(n sub,u/(n; -(n b(h,(n ul,us 9"";4;4 Dis

Dis8un8ungsi gsi (/(u (/(u in,in,*m)*m)e/ene/ensi si ,(/,(/u) u) )(-)(-( ( sis/sis/em em <en<en( ( su)su)e+8ie+8isi(l si(l .ug.ug(( men0eb(b,(n (li+(n -(+(h b(li, 9+e8lu,s; -(n men0eb(b,(n )ening,(/(n /e,(n(n men0eb(b,(n (li+(n -(+(h b(li, 9+e8lu,s; -(n men0eb(b,(n )ening,(/(n /e,(n(n hi-+*s/(/i,4 Keg(g(l(n ,(/u) )(-( <en( su)e+8isi(l se(+( )+ime+ -()(/ /e+.(-i hi-+*s/(/i,4 Keg(g(l(n ,(/u) )(-( <en( su)e+8isi(l se(+( )+ime+ -()(/ /e+.(-i ,(+en( ,elem(h(n 0(ng su-(h (-( )(-( -in-ing )embuluh (/(u

,(+en( ,elem(h(n 0(ng su-(h (-( )(-( -in-ing )embuluh (/(u leafletsleaflets ,(/u) (/(u ,(/u) (/(u se,un

se,un-e+ -e+ /e+h(-/e+h(-() () ,e+us,e+us(,(n l(ngsung 8lebi/is su)e+8isi(l (/(u (,(n l(ngsung 8lebi/is su)e+8isi(l (/(u -is/en-is/ensi si <en(<en( be+lebih

be+lebih (,ib(/ (,ib(/ e8e, e8e, h*+m*n(l h*+m*n(l (/(u (/(u /e,(n(n /e,(n(n /inggi4 /inggi4 Keg(g(l(n Keg(g(l(n <en( <en( )(-()(-( )e+/emu(n

)e+/emu(n sis/em sis/em )+*8un-( )+*8un-( -(n -(n su)e+8isi(l su)e+8isi(l )(-()(-( saphenofemoral saphenofemoral -(n-(n saphenopopliteal

saphenopopliteal 'unctions'unctions -()(/ men.(-i sumbe+ +e8lu,s be+u.ung )(-( &I4 -()(/ men.(-i sumbe+ +e8lu,s be+u.ung )(-( &I4 In,*m)e/ensi ,(/u) <en( su)e+8isi(l -eng(n +e8lu,s -i-()(/,(n )(-( >!H )(sien In,*m)e/ensi ,(/u) <en( su)e+8isi(l -eng(n +e8lu,s -i-()(/,(n )(-( >!H )(sien &D -eng(n +e8lu,s )(-(

&D -eng(n +e8lu,s )(-( G&G& men0 men0umb(numb(ng g (n/(+( 1!!H(n/(+( 1!!H  -(n )(-( -(n )(-( @H@H -eng(n ul,us <en( 9

-eng(n ul,us <en( 9?? 66;4;4 Ke

Kegg(g(g(l(l(n (n ,,(/(/u) u) ))(-(-(( comcommunmunicaticating ing perperforforatoator r veinveinss .u.ug( g( -(-()()(// membe+i ,esem)(/(n m(su,n0( /e,(n(n /inggi ,e sis/em <en( su)e+8isi(l 9

membe+i ,esem)(/(n m(su,n0( /e,(n(n /inggi ,e sis/em <en( su)e+8isi(l 9 11 ;4;4 In

In,*,*m)m)e/ee/ensinsi perforator perforator valvevalve memmembe+i be+i -(+-(+(h (h ,es,esem)em)(/(n (/(n un/un/u, u, menmeng(lg(li+ i+ mun-u+ -(+i <en( )+*8un-( ,e sis/em su)e+8isi(l -eng(n )(,s( ,(+en( /e,(n(n mun-u+ -(+i <en( )+*8un-( ,e sis/em su)e+8isi(l -eng(n )(,s( ,(+en( /e,(n(n /in

/inggi ggi 0(n0(ng g -ih-ih(sil(sil,(n ,(n *le*leh h (,s(,si i )*m)*m)( )( */**/*/4 /4 TTe,e,(n((n(n n l*,l*,(l (l be+be+leblebih ih -()-()(/(/ men0

(25)

se,un-e+4 #(l ini -()(/ men0eb(b,(n -il(/(si se,el*m)*, <en( /e+l*,(lisi+ 0(ng se,un-e+4 #(l ini -()(/ men0eb(b,(n -il(/(si se,el*m)*, <en( /e+l*,(lisi+ 0(ng n(i, )(-( ,(,i 9

n(i, )(-( ,(,i 911;4;4

eb(g(i /(mb(h(n +e8lu,s .ug( -()(/ /e+.(-i )(-( )e+(b(ng(n <en( /(n)( eb(g(i /(mb(h(n +e8lu,s .ug( -()(/ /e+.(-i )(-( )e+(b(ng(n <en( /(n)( (-(

(-(n0( n0( +e8+e8lu,lu,s s <en<en( ( su)su)e+8ie+8isi(l si(l (/((/(u u )+*)+*8un8un-( -( /+u/+un(n(l l (/(u(/(u perforator perforator veinvein 99>>;4;4 Pe+(b

Pe+(b(ng(n 0(ng (ng(n 0(ng )(lin)(ling g se+ing meng(l(mi +e8lu,s se+ing meng(l(mi +e8lu,s (-(l(h 0(ng (-(l(h 0(ng be+hube+hubungbung(n(n -eng(n G& 96!H; <en( s()hen( )(+<( 92!H; (/(u ,e-u(n0( 9"!H;4 P+*ses -eng(n G& 96!H; <en( s()hen( )(+<( 92!H; (/(u ,e-u(n0( 9"!H;4 P+*ses +e8l

+e8lu,s u,s )e+)e+(b(b(ng(ng(n (n /e+/e+is*is*l(si l(si ini ini -()-()(/ (/ be+be+,*n,*n/+i/+ibusbusi i )(-)(-( ( )+*)+*g+eg+esi si )en0)en0(,i(,i// -(l(m segmen <en( su)e+8isi(l (/(u )+*8un-( l(in 9

-(l(m segmen <en( su)e+8isi(l (/(u )+*8un-( l(in 9"";4;4 Obs

Obs/+u/+u,si ,si <en<en( ( )+*)+*8un8un-( -( -()-()(/ (/ melmelimiimi/(si/(si ououtfltflowow -(+(h -(+(h men0emen0eb(b,(nb(b,(n )ening,(/(n

)ening,(/(n /e,(n(n /e,(n(n <en( <en( -eng(n -eng(n ,*n/+(,si ,*n/+(,si */*/ */*/ -(n -(n be+u.ung be+u.ung )(-( )(-( -is8ungsi-is8ungsi )*m)(

)*m)( */*/ */*/ se,un-e+4 Obs/+u,si se,un-e+4 Obs/+u,si <en( <en( -()(/ -()(/ /e+.(-i /e+.(-i ,(+en( ,(+en( )+*ses )+*ses <en( <en( in/+insi,in/+insi, se)e+/i

se)e+/i deep vein thrombosisdeep vein thrombosis 9D&T; (,u/ (/(u s/en*sis <en( (/(u ,(+en( ,*m)+esi 9D&T; (,u/ (/(u s/en*sis <en( (/(u ,(+en( ,*m)+esi e,s/+insi,4 Obs/+u,si

e,s/+insi,4 Obs/+u,si outflowoutflow <en( memili,i )e+(n )en/ing -(l(m )(/*genesis &I <en( memili,i )e+(n )en/ing -(l(m )(/*genesis &I 99"!"!;4 Obs/+u,si <en( )*s//+*mb*/i, s(m( h(ln0( -eng(n -is8ungsi ,(/u) <en(;4 Obs/+u,si <en( )*s//+*mb*/i, s(m( h(ln0( -eng(n -is8ungsi ,(/u) <en( )+*8un-(

)+*8un-( memili,i memili,i /ing,(/ /ing,(/ )e+,emb(ng(n )e+,emb(ng(n ulse+(si ulse+(si <en( <en( -(n -(n )+*g+esi )+*g+esi )en0(,i/)en0(,i/ lebih e)(/ 0(ng /inggi 9

lebih e)(/ 0(ng /inggi 9"""";4;4 Dis

Dis8un8ungsi gsi )*m)*m)( )( */**/*/ / -()-()(/ (/ be+be+u.uu.ung ng )(-)(-( ( )en)eng*sg*s*ng*ng(n (n /i-/i-(, (, e8ee8e,/i,/i8 8 -(+(h <en( -(+i /ung,(i -is/(l4 #(l ini .(+(ng /e+.(-i )(-( ,el(in(n )+ime+ be+u)( -(+(h <en( -(+i /ung,(i -is/(l4 #(l ini .(+(ng /e+.(-i )(-( ,el(in(n )+ime+ be+u)( neu

neu+*m+*mus,us,ul(ul(+ + (/(u(/(u muscle-wasting syndromesmuscle-wasting syndromes4 4 N(mN(mun un -is-is8un8ungsi gsi )*m)*m)( )( */**/*// se+ing /e+.(-i -eng(n (-(n0( +e8lu,s (/(u *bs/+u,si )(+(h4 K(+en( )eng*s*ng(n se+ing /e+.(-i -eng(n (-(n0( +e8lu,s (/(u *bs/+u,si )(+(h4 K(+en( )eng*s*ng(n <e

<en( n( /i/i-(-(, , e8e8e,e,/i/i88 immimmediediate ate pospostamtambubulatlatory ory venvenous ous prpresessursuree (,((,(n n h(mh(m)i+ )i+ se/inggi /e,(n(n se/el(h be+-i+i l(m(4 Dis8ungsi )*m)( */*/ /(m)(,n0( men.(-i se/inggi /e,(n(n se/el(h be+-i+i l(m(4 Dis8ungsi )*m)( */*/ /(m)(,n0( men.(-i me,(nisme signi8i,(n -(l(m )e+,emb(ng(n ,*m)li,(si se)e+/i ul,us <en( 9

me,(nisme signi8i,(n -(l(m )e+,emb(ng(n ,*m)li,(si se)e+/i ul,us <en( 9"2"2;4;4 Pe+

Pe+ub(ub(h(n h(n hemhem*-i*-in(mn(mi, i, )(-)(-( ( <en<en( ( bes(bes(+ + /un/ung,(g,(i i -i/-i/+(n+(nsmissmisi,(i,(n n ,e,e si+,ul(si mi,+* -(n meng(,ib(/,(n be+,emb(ngn0( mi,+*(ngi*)(/i <en(4 eb(g(i si+,ul(si mi,+* -(n meng(,ib(/,(n be+,emb(ngn0( mi,+*(ngi*)(/i <en(4 eb(g(i /(m

/(mb(hb(h(n (n -is8-is8ungungsi si ,(/,(/u)u) microvenousmicrovenous /(m)(,n0( memili,i )e+(n ,uni -(n /(m)(,n0( memili,i )e+(n ,uni -(n

--()()(/ (/ /e/e+.+.(-(-i i inin--e)e)enen--en en /(/(n)n)( ( --isis8u8unnggsisi macrovenousmacrovenous 99"3"3;4 ;4 G(G(ngnggugu(n(n hem*

hem*-in(mi-in(mi, , ini ini be+,*be+,*n/+ibn/+ibusi usi )(-( )(-( /imbu/imbuln0( ln0( /emu(n mi,+*(ngi/emu(n mi,+*(ngi*)(/i 0(i/u*)(/i 0(i/u el

el*n*ng(g(sisi  -i-il(l(/(/(si si -(-(nn tortuositytortuosity ,(),()ileile+ + )en)eneb(eb(l(n l(n memmemb+(b+(n n b(s(b(s(l l -en-eng(ng(n be+/(mb(hn0( se+(/ ,*l(gen -(n el(s/is ,e+us(,(n en-*/el -eng(n )eleb(+(n el(h be+/(mb(hn0( se+(/ ,*l(gen -(n el(s/is ,e+us(,(n en-*/el -eng(n )eleb(+(n el(h

(n

(n/(+ /(+ enen-*-*/e/el l -(-(n n bebe+/(+/(mbmb(h(hn0n0(( pericallipary pericallipary edemaedema -en-eng(n g(n 8*+8*+m(sm(si i h(lh(l** n(mun