Case Bedah Hemoroid

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PRESENTASI KASUS

HEMOROID

Pembimbing:

Dr. Eka Swabhawa Uttama, SpB c c c c c c c Oleh:

Labiqotul Lubabah Ahasmi 106103003449

KEPANITERAAN KLINIK ILMU BEDAH RUMAH SAKIT UMUM PUSAT FATMAWATI PROGRAM STUDI PENDIDIKAN DOKTER

FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN UNIVERSITAS ISLAM NEGERI SYARIF HIDAYATULLAH

JAKARTA 2010

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LEMBAR PENGESAHAN à c c c c c c c cccc c c c c cc c cc cc ccc !c"#"c$c%c c"##c c c c c c c c&c"#"c c c c c '(c) c c c*+c c c c c c c c c c c

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KATA PENGANTAR c , c c- c c c c c c, c.c c c c c c c c c c c c c c (c c c c c c / c c c c cà c,.(c , c c c c c (c & c c c c c c/ c c c c c c(c c c c c c c c c (c c / c c c c (c ) c c c *c c c c c c c c c c c c c(c c c c cc&cc"#"c c c cccccccccc c

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DAFTAR ISI

LEMBAR PENGESAHAN ... ii

KATA PENGANTAR ... iii

DAFTAR ISI ... iv

BAB I ILUSTRASI KASUS A. IDENTITAS PASIEN ... 1 B. ANAMNESIS ... 1 C. PEMERIKSAAN FISIK ... 3 D. PEMERIKSAAN PENUNJANG ... 5 E. RESUME ... 5 F. DIAGNOSIS ... 5 G. DIAGNOSIS BANDING ... 6 H. PEMERIKSAAN ANJURAN ... 6 I. PENATALAKSANAAN ... 6 J. PROGNOSIS ... 6

BAB II TINJAUAN PUSTAKA A. PENDAHULUAN... 7

B. ANATOMI DAN FISIOLOGI ANOREKTAL ... 7

C. DEFINISI HEMOROID ... 11

D. PATHOGENESIS ... 12

E. KLASIFIKASI DAN DERAJAT ... 12

F. GEJALA DAN TANDA ... 13

G. PEMERIKSAAN ... 14

H. DIAGNOSIS BANDING ... 14

I. TATALAKSANA ... 15

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BAB I ILUSTRASI KASUS A. IDENTITAS PASIEN (càc c c 0c"#"11"#"c c c c 0c(c2/c c c c c 0c1c c c3 c c 0c4 5 c , c c c 0c6 c , c c c 0c c c c*c#c(ccc""7"8c c c c* c c c 0c, 7 ! c c c 0c cc c c 0c3 c cà cc 0c#9c&c"#"ccc c c c B. ANAMNESIS & c c c c#9c&c"#"ccc c (c 1. Keluhan Utama * cc c c c c1c cà(cc 2. Keluhan Tambahan * c c c c (c 3. Riwayat Penyakit Sekarang

c c c c c c c c c c 1c c à(c * c c c c c c c c c c c c:c c c c c c c c c c c / c c c c c c c c c c #c c c c c c c c c c c c c c c c c c c c c c c / c c c c c c (c * c c c c c c c c c c c c 1c c àc c

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c c c c c c c c c c c c c c c (c c c c c c c c c c c (c c c c c c c c (c & c c c c c c / c c ;(c à c c c c c c c cc c c c c c c c c c c c c c c c c (c c 1c c c c c c 5 c c c c c c c c c c c / 7(c ) c c c c c c / c c c (c c c c c c c (c c c c c c c c c c c c c c c c c c c c c#c cc.2c c c c (cc c c c c c c c c c c c c c c c c c c (c c c c c c c c c c c (cc c c c c c c c c c c c c c c/ c c; c c c(c& c c c c c c c c c (c c c c c c c c (c * c c/c c c c c c c cc c cc c(c c c c c c c c c c (c c c c c c c c ; c c c c c c (c c

4. Riwayat Penyakit Dahulu

c c!c cc c/c c cc (c c c c c c c c (cc

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5. Riwayat Penyakit Keluarga c c c c c c c c c c c (cc c cc/c c c c c c cc (c 6. Riwayat Kebiasaan c c c c c c c 5 c c 5 (c c c c c c c:c c c c c c c c 5 c c 5 (c c c c c c c c c (c c c c c c c c c c c c c c#c c c1c c c c c c:c c c c c c#c c c:5<c c c (c c c c c c c c c c (c,! c c 5 c c cc c (cc c c c c cc (c c C. PEMERIKSAAN FISIK 1. STATUS GENERALIS a. Keadaan Umum : c c b. Kesadaran : 3c c. Tekanan Darah : ##"7<"c d. Frekuensi Napas : "c=7 e. Frekuensi Nadi : <%c=7 f. Suhu : 1<9"2 g. Kepala ; c c c c c c c/ ( h. Mata 3 ! c c>7>c/ cc575 i. Hidung c/c575cc575

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ÿ. Telinga c/c575 k. Mulut ÷ c; c c( l. Leher c cc ( m. Thoraks Paru 6c 0c c cc c c c c c 0c!/ c; c c cc c c (c c 0ccc c c c , 0c c c! cc575c?c575c Jantung 6c 0c cc c c cc 0c cc cc62c@c c/ !/ c c c 0c c * c c 0c62c6@c c c c * c cc 0c62c@c c/ !/ c cc c c 0c62c666c c c c c , c0c c c6c66c c c'5+c'5+c n. Abdomen 6c 0c& c c 0c cc c'5+c c 0c cc c c c , c0c*c c'>+c o. Ekstremitas , c c c'5+c c c c

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2. SATUS LOKALIS c cc 6c0c cc c1c c c c c c c c c c c cc=cc=cc/(cc c0cc c'5+cc c c (c c D. PEMERIKSAAN PENUNJANG * c c (c c E. RESUME c c 5 c c 1c c c c c c c c c c c1c cà(c* cc c c c c c:c c c c c c c c c*,*c c c c c c *,*(c c c c c c c c c *,*c c c c c c c c c #c (c c c c c c c c c c c c (c c c c *,*c c c c c c / c ;c c c c c c(c*,3c c c cc c'5+c c'5+(c c c c c c c c c c c c c ! c ;(c c c c c c c (c c c ;c c c c c ! c c c &c ##"7<"c (c c c c c c c c (c c c c c 6c 0c c c c 1c c c c c cc cc c c c cc=cc =cc/(c c0cc c'5+cc c c (cc F. DIAGNOSIS c c c6@c G. DIAGNOSIS BANDING c

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H. PEMERIKSAAN ANJURAN c c cc c I. PENATALAKSANAAN Medikamentosa cc @c3c 4 = cc cc Non medikamentosa * c c c c * c c c c * c c J. PROGNOSIS ,c! c c 0c* cc ,c c 0c c c c ,c c 0c c c c

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BAB II TINJAUAN PUSTAKA A. Pendahuluan c c c c c c/ c c c c cc 5 (c&c2àc cc c' c#AA1c(c&c#AA8+c c 8#8c c c c c #"%c ':"AB+c c (c c c cc c c c c cc c (c3 c cc c 0c c c c c c c c c c c c c c c c c c c 5 (c c c c c c c 5 c c c c c c c 5 c c c c c c c c c c (c c c ; c c / c c c 0c c cc c c c/ c c c c c c c c c c c c ; c c c c c c c c c c ' c c c +c c c (c c c c c c / c/c c/ c c c c (#c

B. Anatomi Dan Fisiologi Anorektal

c 3 c c c c c c c ! c /c c/ c c c(c3 c c c c c/ cc c c ; c c c ! c c ; c c c c c c c (c / c c c c c c c c c c c c c c c c c c (c c c c c c (c & c c / c c c c c c c c (c 3 c c c c c c c c ; c c c c c c c c c c / c c ; c c c c c c (c c c c c c c / c c ; c cc (c& c! cc c c c c cc

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c c c c c c ccc ! c c/ c! c (c & c c c c c c c / c c c c ;c c c (c c ;c c / c c c c c;c c c c cc c c ;c c c c ;c c c c ;c c c c c c c c c c (c c 3 c c c c c c 1c /(c c c cc ! c c c c / c c c c c c c c c / c c c (c c c ; c c c c c (c * c c c c c c c c c c c c c (c&c cc c c c c c c c c c/ (c6;c c cc c c c c c c c ;(c 4 c c ;c c c c c c c c c c/c c c c c c;c c c;c c' c+(c c 2/c ;c c c c c c c c ;cc c ;c (c c c c c //c c c c ; c ;c c c c c c c c ! c ' +c c c (;c (c à(;c c c c c c c c (;c cc c cc (c

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c c c ,c c c c c c ( c ;(c ,cc cc c c/ c 0cc c (c2 c c c c/ c (c4 c c/ c cc c c c cc c c c cc c c(c c ,c c c c / c c ( c c c ( c ;c c / c ( c (c , c c / c c ;c c c c c c c c c c c c c c c c c c / c c c ( (c, c cc c cc ;c c c cc c c (c c c c c c c c c c c c c c c c c c c c c c c c ! c c (c c c

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c! c c @ c c c c c c c c c c c c c c c ! c c ;c c c c ! c c c ! c (c @ c c c c c c c c c cc (c3 c/ c c c c c ! c c c c c c /c c c ;(c @ c c;c c cc c! c c c cc c ! c c c c c ! (c c ! c c c c c(c c;c c c ;c c c c c c c c c c c c c ;c c c c c / c ;c c c c c c ;c (c 6;c c c c c c c c c ; c (c c ;c c / c c c c c cc c! c c c c cc c ;c c ;c c (c C c c c c c / c c c c c c c;c(c ; c c ; c / c c c c c c (c c c c c c c ;c c c c c c c c c c c c c c c (c c c c c c c c c c c c c c c cc c c c (c ; c c'!c+c c c / c c c c (c c ;c c c c c cc cc c cc c/ c c c c c c c (c Cc c c / c ;c c c c c c c c c c c / c c c c c c; c! c c c c; c (c

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c à c c c c Dc c c c c c c c c c c c (c &; cc c c c c/ c(c c;c cccc c / c 5 c / c c c c c (c * c c c c c c / c c c / c c c c ; (c / c c c c c c c c c c/ c c (c c c c c ; c c c c c c c c c (c &; c c c ;=c /c / c c c c c c;c c (c c c c; c c c ; cc c cc/ c c ; c;c c c c c c c (cccccccc C. Definisi Hemoroid c c c c; c c c! cc c c c c c c (c c c c c c c (c c c c c !( c c c c c c c c c (c c c c c c ! c c c c c c / c c (ccc c c ccc c 5 c 5 c c c (c c c c /c c c c c cc (ccc c c c c c c c c ;c c c c c c c c c c c c c (c 3 c c c c c c c c / c c c c c c c ! c c c c c / c

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c c c (c c c c c c c !( c c c c c ! c (c c c cc c c c c c c c c c c c c !( (c D. Pathogenesis c c c c c c c ; c ! c c c cc; 5; c7/ (c c c c c c c ; c c c c c c c c c c c c c c 'c c c c c c c c c c c c / c +c c c c c c c' c c c +c c' cc c c c c c c +c c c cc cc c c c c c c c c c c c c c c c' c c +c c 7 (cc

E. Klasifikasi dan deraÿat

c c c ; c c c c c (c c c c c cc 0c #(c & c#c * c c cc c c cc c c (c c c c c (c (c & cc c c c c c c c c c c c c/ c (c 1(c & c1c c c c c c c c c c c c c c (c 8(c & c8cc

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c c c (c c c / c c c c c; (c c c / c c c c c c c c 'c 7c c c +c c c c 'c 7c c c c +(c c c c c c c c c c c c c c c c c c c c c c (c / c cc c c c c c8c (c F. Geÿala dan tanda

c cc c cc c c c c c c c/ c c c c (cc #(c c c c c c c c c c c c c c c c ccc c c(c (c cc c c c c ccc c c c ;c c (c & c c c c c c c c / c ;c c c c c c ;c c c c c c ;c c c c c c c c c c c c cc c (c

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G. Pemeriksaan , c c c c c c c c c cc cc c / c c c c c c c (c c c /c c c c c c c c ! c c c c / c c c c c (c 2c c c c c c c/ (c c c c c c c c c c c c (c,c c c c c c c (c cc c c c! / c ccc c (c c c c c c c c c c c c c c c cc (c c c c c c c c c c c c c c c c c c cc c c c c c ;c c c c c (c c c c c c c (c H. Diagnosis Banding c / c c c ; c c c c c c c c c c !c c /c c c c c c c c c c c (c c c c (cc cc cc cc/ c ;c c c c c c (c c / c c c c c c c c c (c 3 c c c c c c c c c c c c c c (c 4 c c c c c c c cccc c c c (c, c c c c c c c c c c c c c c ; c

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I. Tata laksana c c c c c c c / c (c c c c c c c c c c c c c c c (c 3 c cc c c c c cc c c / c c c c c c (c à c c c c c c (c à c c c c c c c c c c c; c c c c c / c (c c c c c c c c ;c c c / c;c c c (c c c c c c c c c c c c c/ c c c c c c cc/ c c c (c c c c / c c c c c (c , c c c c c c c c c c 2c c /c c c c c c (c cc c c c c c c c c c 9Bc ;c c c (c c c c c c c c c c c c c c c c c c cc c c c;/c c c (c c c c c c c c c c c c c c (c, c c c c c c c c c c(c c c c;c c c c cc c c c c; c c c c (c c c c c c c c c c c c c c;;c ccc c6c c66(c

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c 4 c c c c c c c c c c c c c c c c c c c * (c & c c c c c c c ccc c c c c c c c (c E c c c c c c c c / c c c c c c c (c c c c c c c (c à c c c c c(cc c c c c c c c (c c c c c c c c c c c c c c c c c c c c (ccc

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c c c c c c c cc c c c (c c c c c c c c / c c c c (c c c c c c c c ;(c c c c c c c c c c c c c c (c * c c c c c c c c c c c c c (c * c c c c c c c c / c c c c c c c c c (c * c c cc //c c c ;c c c/ c c (c

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cc c c c c c c c c c c c c c c c 666c c 6@(c c c c c c c c c c c c c c c c c / c c c c c (c c c c 6@c c c c c c c cc c c(c c c c c c cc cc c c c c c c 5 c (c )c c c c c c c c c c c c c ;c (c c c c c c & c c c c c c c c c c c c c c c cc c c c c c

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c; cc c c(càc c c4c c c c c c c c (c c & c c c c c c c c c c (c c ! ;c c c c c c c (c c c c c c c (c c c c c c c c c c c c c c c/ c c c c(c c c c c c c c c c c c c c

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BAB IV ANALISIS KASUS c 5 c1c c c c c c c cc c c1c cà(c cc c c c c c*,*c c c cc c c c c c / c c c *,*c c c c c c c c c c c c (c * c c c cc c c c cc c c c c c c c c c c c (c , c c c c c c c c c c c *,*c c c c c c c c c c (c cc c c c c c c *,* (cc c c c *,*c (c 3 c c / c c c c (c , c c c / c c c c (c , c c c c c c c c c c ' ? +c c c c ' +c c c c c c (c c * c c c c c c c c c c c / c c (cc * c c c c c c c c c c c c c c c c c c ; c c c ;c ' +(c & c c c c c c c / c c ;c c (c * c c c c c c c ; c (c c c c *,*c c c c c(c cc c cc c; c c c c*,*c c c(c&; c c c c;c cc c c; c c (c c c c c c c c c c c c ! c;(c c c c c cc (c c;c c c c c ! c c c&c##"7<"c (c c c c c c c c (c c c c c 6c 0c c c c 1c c c c c cc cc c c c cc =cc =c c /(c c 0cc c '5+c c c c (cc c c c / ! c c c c c c c

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; c c (c c c c c %c 74c / c ; c c c c c c c c c(c c c c c c c c c ; c c / c c 4 = (c , c c c c c c ; c c c (c c c c c c @(3c c c c (c c c c c c c c c c c (c& c cc c(c c

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BAB V PENUTUP DAFTAR PUSTAKA #(c à((c & 0c c ,.c (c (c c #(c )c 9(c 0c c c & c 6 c c & c 36Dc ""A(c c9%<5A"(c (cc.&c c(c (c 0c)E2Dc""9(c c:<5<9(c 1(c! c ,(/(c E c c E (c ;c 3c 3c 5c (c c0cc* c3 c)E2cDc""9(c 8(c cc c,c,?c(c cc (c& c0c3 c c3 (c à c,/ c36(c#A%(cc1:58(c 9(cc