Koran Digest Senin 30 Des

KORAN BEDAH DIGESTIFSENIN, 30DESEMBER 2013

PALEM ATAS (Indah085242057423)

No BedIdentitas Diagnosis Pemeriksaan Penunjang Terapi

1 B1/1 Laode halim12/5/199419 tahun MRS : 15/12/13RM : 606587

Askes

DR. dr. Ronald E. Lusikooy, Sp.B, KBD

POH 15 laparatomy ekplorasi + splenoctomy ec Trauma tumpul abdomen

Lab 26/12/13WBC 17,82 RBC 3,59 HGB 9,9 HCT 30,7 PLT 914Lab 18/12/13 :CRP : 45,0, GDS : 90, UR/CR : 31/0,80, BIL total : 0,58, bili direk : 0,21, GOT/GPT :64/31, Alkali fosfat : 57, protein total : 5,6, albumin : 3,2, CT/BT : 7/3, PT/APTT : 13,4/24,4, INR : 1,12, Na/K/Cl : 134/3,5/100

Lab 16/12/13 :WBC : 12,49, RBC : 3,13, HGB : 9,3, HCT : 26,8, PLT : 151, PT/APTT : 13,6/25,6, Na/K/Cl : 134/5,9/108,GDS : 153, UR/CR : 31/1,1, GOT/GPT : 53/26, ALB : 2,5

USG Abdomen : (15/12/13)Hematoma lien disertai cairan bebas intraperitonium

Terapi sesuai TS ortopediMobilisasi dudukDiet bebas

2 B2/4 Bed 2

Ny Sallama31/12/196646 Tahun636819MRS 12/11/2013KONSUL 14/11/13Askes Wajib

Dr.dr Ibrahim Labeda, Sp.B KBD

POH 17Drainage ascitesAdenocarsinoma Colon Ascendens Residif

Lab 27/12/13GDP 226Lab 24/12/13WBC 16,8 RBC 3,49 HGB 9,7 HCT 26,9 PLT 675 Ur/Cr 65/0,61Lab 21/12/13SGOT/SGPT 94/89Lab 0 6 /12/2013 WBC 10,9, RBC 3,73, Hb 10 HCT 29,7 PLT 591, Prot.total 5,6, albumin 2,7, globulin 2,9, Na/K/Cl 129/4,1/100GDP: 104, Chol.tot: 112, HDL direk: 13, LDL direk:69, TG: 107.Lab 3/12/2013 Globulin : 3,7, GDS : 250, Ur/Cr : 11/0,59, SGOT/SGPT : 28/26, Prot.total 6,1, Albumin 2,4, CT/BT : 9’00/4’00 PT : 15,4 control 12,4, INR : 1,24, APTT : 25,0 control 24,0, Na/K/Cl : 124/3,9/97Lab 02/12/2013 WBC 13,77, RBC 3,45, Hb 9,3 HCT 27,0 PLT 632, GDS 250, Ur/Cr : 11/0,59, SGOT/SGPT : 28/26, Prot.total 6,1, albumin 2,4, globulin 3,7, PT/APTT : 15,0/25,0, INR : 1,24, CT/BT : 9,00/4,00 Na/K/Cl 124/3,9/9,7Lab 30//11/2013WBC 15,45, RBC 4,1, Hb 10,6, HCT 31,4 PLT 598, Na/K/Cl 131/3,6/113

- IVFD NaCl 0,9% 28 tts/menit

- Vip Albumin 3x2 caps

- Takar produksi ascites/hari

- Cefotaxime 1gr/12j/IV

- Susu 5 x 200 cc- Cek elektrolit- Terapi TS gizi

klinik & interna lanjut

1


Lab 27/11/13GDS 150, Na/K/Cl 128/4,0/104Lab 26/11/13WBC 13,4, RBC 3,78 Hb 9,8, HCT 29,4 PLT 525Lab 22/11 /13 WBC : 16,2. HGB : 7,8. RBC : 3,13. HCT : 24,8. PLT : 6,58. (Anemia mikrositik hipokrom, trombositosis,leukositosis)Colon In Loop 21/11/2013Tidak tampakcolon ascendens dan 1/3 proximal colon transversumLab 19/11/13WBC:9,5,HGB:11,0,HCT:30,6,PLT:553Lab 18/11/13CEA : 1,8, CA 19-9 : 9,99Lab 16/11/13WBC:14,37,HGB:9,11,HCT:27,7,PLT:507Hasil PA 10/06/13Adenocarsinoma colon , moderatelu differentiated dengan kedua ujung reseksi bebas tumorFoto thoraks PA 13/11/13Tidak tampak tanda tanda metastasis pada foto thorak iniMSCT scan abdomen 13/11/13:Massa colon ascendenas dengan tanda tanda obstruksi usus di proximalnya Hepatospenomegali, tidak tampak tanda tanda metastasis ke hepar.Lab 13/11/13 :Na/K/Cl 135/4,2/108, Bilirubin total : 0,1, Bilirubin direk : 0,1, Alkali fosfatase : 69, Gamma GT : 18

3 B2/6Bed 1

Ny. Thalha Kasim 12/10/195756 thnMRS: 7/12/2013RM :640024

ASKES

Dr.dr Ibrahim Labeda, Sp.B KBD

Tumor rectum 1/3 tengah

LAB (21/12/2013):WBC 9.64, RBC 3.38, HGB 9.3, HCT 26.6 PLT, HBsAg non reactive, PT 11.7 kontrol 10.9, APTT 24.4 kontrol 23.9, GS 145, Ur/Cr 39/ 0.7, GOT/GPT 41/45, Na 142, K 4.3, Cl 11.6, Albumin 3.6ECHO (18/12/13) :Disfungsi Diastolik EF 73%LAB 18/12/13 :GDS : 171, Protein total : 6,2, Albumin : 3,5, CEA : 2,57Foto polos abdomen + colon in loop : (10/12/13)Tumor rectum proximalCT-Scan Abdomen (16/12/13) :Massa recti 1/3 distal (dukes B ) Thorax PA 9/12/2014Kesan: cor & pulmo normal. Tidak tampak tanda-tanda metastasis pada foto ini.

- HP Pro 3x1 tab- Rencana operasi

selasa 31/12/2013 oleh Dr.dr.Ibrahim labeda Sp.B-KBD

- Colon skema hari I (Ahad, 29/12/13)

2


Lab 7/12/2013WBC 7.51, RBC 3,62, HB 10.1, HCT 28.2, PLT 241, GDS 151, Ur/Cr : 31/0.7, SGOT/SGPT : 201/198, PT/APTT : 12.6/25.8, INR : 1.00, CT/BT : 8’/2.30’,Na/K/Cl: 145/4.10/112

PALEM BAWAH (Indah 085242057423)4 B1/K3 Ny.elva hendarsin

12-04-197142 thnMRS : 16/12/13RM :640406

Askes

DR. dr. Ronald E. Lusikooy, Sp.B, KBD

POH 10 Laparatomy +unroofing kista hepar

Lab 17/12/13CT/BT 8/3’30” PT/APTT 14,2/27,1 INR 1,19 GDS 69 SGOT/SGPT 20/14 WBC 8 RBC 4,39 HGB 12,2 HCT 35,0 PLT 279Lab 06/12/13 :RBC ; 4,78, WBC : 13,1, HGB : 13,1, HCT : 38,1, PLT : 304, GDS : 102, UR/CR : 19/0,65, Bilirubin total : 0,68, bilirubin direk : 0,23, GOT/GPT : 18/13, Protein total : 7,2, albumin : 4,5, tumor marker CA 125 : 36,69CT-Scan abdomen :05/12/13Multiple kista heparMassa padat ovarium kanan DD/Mioma uteri

- IVFD RL 28 tts/mnt

- ceftriaxone 1 gr./24jm/iv

- Ranitidine 1 amp/8jm/iv

- Diet bebas- Susu 5x200cc- Mobilisasi

duduk- Takar produksi

dran/hari

5 B2/4Bed 1

Tn. Pither Tandipayung28/2/195855 tahunRM 384339MRS 23/12/2013

ASKES

Dr.dr. Warsinggih Sp.B-KBD

CKD stg V on HD regular post CAPD H3

Lab 27/12/13PT/APTT 12,3/24,6 INR 1,00 Ur/Cr 76/4,7 Na/K/Cl 133/4,4/109 WBC 24,87 RBC 3,54 HGB 10,3 HCT 29,7 PLT 260LAB(24/12/2013):HBsAg non reactive, Na 136, K 5.1, Cl 101, BT 2, CT 8, PT 14,6 kontrol 12.1, INR 1.22, APTT 33.4 kontrol 26.7, GDS 64, GOT 37, GPT 62, Protein Total 5.9, Albmin 3.66, WBC 15.6, RBC 3.71, HGB 11, HCT 30.7, PLT 299USG Abdomen (11/11/2013):PNC bilterl kist ginjal kiri + ascites

IVFD RL 20 tpmCeftriaxon 1gr/12jam/IVRanitidin 1amp/8jam/IVKetorolac 1amp/8jam/IVTerapi lanjut TS interna

7. B2/9Bed 2

Tn/ Budimawan Aris23/9/199023 tahunMRS : 18/12/13RM : 603878

AskesDr.dr.Ibrahim Labeda, Sp.B (KBD)

Haemorroid grade II-III

LAB 20/12/2013:BT 3, CT 8, PT 11.9 kontrol 12.1, INR 0.99, APTT 26.3 kontrol 25.5, GDS 97, Ur/Cr 23/1.1, GOT/GPT 18/ 31, WBC 3.2, RBC 5.15, HGB 16, PLT 274, HCT 45.6ECHO 17/12/13 :Fungsi sistolik dan diastolik LV Baik , ef 63%Normal echocardiogramLAB 26/11/13WBC : 3,7, RBC : 5,28, HCT ; 46,4, PLT : 293, CT/BT : 8/3, PT/APTT : 13,0/27,2, na/k/cl : 140/4,0/105

Venosemil 3 x 200 mgCiprofloxacin 2x 500 mgNeurodex 1 x 1 tabTunggu hasil colon in loopRencana op hemorroidektomi dgn staplerTunggu jadwal op

LONTARA I Rezky Astarini (082393647334)

8 L1AD RPK B3

Tato Lando1/7/1945641206MRS 9/12/13Konsul dari interna : 11/12/13

Ileus obstruksi parsial e.c susp. Ca recti 1/3 tengahPOH 4Colostomi

25/12/2013Wbc 5.98 Rbc 2.49 Hb 7.4 Hct 21.6 Plt 136 ur/cr 55/0.8 got/gpt 117/82 alb. 1.423/12/2013WBC 3.4 RBC 292 HGB 8,9 HCT 24,7 PLT 102 Na/K/Cl 129?2.4/100 GDS 122 Ur/Kr

- IVFD RL 28tpm- Omeprazole vial/12j- Inpepsa 3x2 cth- Antasida syr 3x2 cth- Coctail drip/12j

3


JKS 24/0.84 Alb 1.613/12/2013Gol. Darah AB+WBC:11,62 RBC:4,87 HGB:14,5 HCT:43,2 PLT:222 GDS:140 ur/cr:40/0.8 GOT/GPT:27/41 Albumin:2,6 PT/APTT:13,8/22 INR:1,09Na:150 K:3,2 Cl:117Laboratorium 10/12/13CT : 7’30 BT: 3’00 PT : 13,1 APTT : 34,6 GDS : 93 Ureum : 59 kreatinin 0,9 GOT : 33 GPT : 31 protein total : 4,4 albumin : 2,6 Na : 144 K: 3,7 Cl : 112 WBC : 7,31 RBC : 4,55 HGB : 13,7 HCT : 38,9 PLT : 160

9 L1ADK3B3

Dg. Ngintang31/12/1957640694Konsul dari interna 9/12/2013

dr. Murny Rauf, Sp.B-KBD

Ikterus Obstruktif e.c batu CBD mutlak

23/12/2013Ur/Kr 28/0.63 Bil tot 1.35 Bil direct 0,81 SGOT/SGPT 25/15 Cholesterol tot 208 HDL 28 LDL 87 Trigerilserida 213 CT/BT 7.30/2.00 PT/APTT 12.5/26.0 Na/K/CL 132/3,9/104Foto Thorax 23/12/2013Cor dan pulmo dalam batas normal1 3 /12/2013 Bil. Total : 2,48 Bil. Direct : 1,09Lab 10/12/2013CT/BT 8/3; PT/APTT 12,2/24,5; Na/K/Cl 130/3.8/95; AFD 4.92; GDS 342 ; Bil tot 1.55;Bil Direct 0.78Lab 9/12/2013RBC : 3,75 WBC : 12,1 HGB : 10,5 HCT : 30,9 PLT : 4967/12/2013WBC : 15,33 RBC : 3,95 HGB : 11,4 HCT : 31,8 PLT : 300 GDP : 231 Kol Tot : 215 HDL : 3 LDL : 151 Tg : 3066/12/2013PPT : 13,0 APTT 24,1 GDS : 241 Ur : 12 Cr : 0,5 GOT : 31 GPT : 16 Na : 140 K : 2,8 Cl : 1035/12/2013WBC : 16,77 RBC : 4,16 HGB : 11,9 HCT : 32,9 PLT : 202USG Abdomen 6/12/2013- Cholestatis intra hepatic dan ekstrahepatik

e.c multiple choledocolith disertai pneumobilier- cholelith disertai cholesistitis- ascites- efusi pleura bilateral

- Terapi sesuai TS interna- Penjadwalan operasi

CBC

10 L1AB K1 III B5

Arifin 641720 21/5/2013MRS 12/12/13Konsul dari

Ikterus obstruksi e.c Ca caput pancreas

Lab 23/12/2013Wbc 11.50 Rbc 2.76 Hb 9.5 Plt 445 Lab 19/12/2013CT/BT 3/8 ; PT/APTT 13.3/50.2

-tunggu jadwal operasi -optimalisasi KU

4


interna 14/12/13Jamkesda

Lab 16/12/13CT/BT 8’/3’ PT:12,9 APTT:36,5 INR:1,08Laboratorium 13 / 12/13 CT : 9’00 BT : 4’00 PT: 28,1 APTT 60,2 Na : 134 K : 4,0 Cl : 104 GDS: 98 Ur : 20 Cr : 0,54 Bil. Tot : 15,13 Bilirubin direct : 13,34 GOT : 177 GPT : 207 Alkali fosfatase : 2111 Gamma GT : 939 albumin :3,0 Ca :7,1 TIBC :303 AFP : 1,08 Ca 19-9 :>5000Foto Thoraks:Kesan : Pulmo normal, elongation aortaUSG Abdomen 5/12/13-cholestatic intra dan extra hepatic e.c tumor caput pancreas

11 L1BBK6 II B2

Mardiah5/5/197064.1539MRS : 12/12/13 konsul dari interna : 14/12/13

Dr. Samuel, Sp.B KBD

Ikterus ostruksi e.c Baru CBD + gallstones

Lab 23/12/2013Wbc 5.0 Rbc 4.42 Hb 10.9 Hct 32.5 Plt 236 Pt/aptt 14.9/33.2Lab 20/12/2013PT/APTT 15.3/33.3 ; WBC 3.8;RBC 3.76; HGB 9.3; HCT 27,5; PLT 218Bil tot 19,34, Bil direct 16,38 SGOT/SGPT 84/22; Alb 2,6, Na/K/cl 137/3.32/115Lab 19/12/13Ca 125 : 216; CEA : 0,79 : Ca 19.9 <3.00Lab 14/12/13WBC:4,25 RBC:4,14 HGB:9,2 HCT:19,2 PLT:323 Kol.Total:215 LDL:191 HDL:4 Trigliserida:148 As.Urat:3,1Laboratorium 12/12/2013WBC : 5,18 RBC : 2,64 HGB: 4,3 HCT : 15,8 PLT : 412 PT : 18,3 APTT : 38,9 GDS : 87 ureum : 14 kreatinin : 0,5 bilirubin total : 18,5 bilirubin direct : 15,97 GOT : 89 GPT : 22 protein total : 6,5 albumin 2,0 globulin : 44 Na : 136 K : 3,1 Cl : 106CT Abdomen 12/12/2013 - Choleliyh dan choledocholith

menyebabkan dilatasi bile duct intra/extra hepatic

- Ascites

Rencana operasi senin

12 L1ABK1 III B1

Tonda3/4/194964.15.78MRS : 13/12/2013Konsul dari interna :14/12 St/2013

-Cholecyslithiasis-DM tipe 2 non obese

Lab 19/12/2013Bil tot 0,35 : Bil dirct 0,09; Alb 3,2; HbsAg Non reactiveColon in loop 18/12/13Tidak Nampak massa intraluminair kecuali diverticulosis colonSputum BTA (-)CT abdomen 19/12/13Hepatomegaly dgn cholesistisis intra dan extrahepatic, cholecystisis dgn cholelitiasisLab Urine rutin 16/12/13pH:6,0 BJ:1,030 Glukosa:+++/500 protein:- Leukosit:- Blood:-

- Tunggu jadwal operasi

5


WBC:6,2 RBC:4,15 HGB:10,5 HCT:30,5 PLT:420 GDP:159 Gamma-GT:174 Bil.Total:0,32 Alkali phosphate:163 HbA1c:10 Ur:18 Cr:0,7 Na:133 K:4,4 Cl:105Lab 14/12/2013GDP:141 Ur:19 Cr:0,7 GOT:27 GPT:74 Alb:3,1 Kol.Tot: 199 HDL:28 LDL:164 Trigliserida:110 As. Urat:3 WBC:11,1 RBC:4,6 HGB:11,7 HCT:35,5 MCV:77,2 MCH:25,4 PLT:489USG 12/12/2013Colelith disertai cholecystitis

13 L1 BBK6 III B6

Ny Maya1/07/1967

Cholelitiasis 24/12/2013Wbc 16.7 Rbc 7.75 Hb 20.3 Plt 239 Hct 58.7LAB:WBC 47.84, RBC 4.53, HGB 12.2, HCT 37.1, PLT 10.3Lab 16/12/13WBC 13,72; RBC 3,64; HGB 11,5;HCT 33,5;PLT 288; CEA 2.27Lab 18/12/13Urine rutin PH 6; BJ 1020 Prot(-) Glukosa(-) Bilirubin(-) keton(-)EchocardiographiFungsi diastolic LV baik EF 75%,Disfungsi diastolicFoto thorax 29/11/13,Tidak tampak kelainan pada fotoCT whole Abd 6/12/13 Cholelitiasis,asites minimalUSG 29/11/13Cholelith

- Cek Alp/GGp, Ca 19.9- Vit K/24 jam

14 L1ABK2B5

Jenne01/07/1932642425Konsul dari interna 22/12/13

Hemoroid grade IV

27/12/2013Wbc 35.6 Rbc 4.14 Hb 11.5 Hct 33.2 gds 85 as.urat 7.8 alb.3.0 pt/aptt 13.2/30.9USG Abdomen 27/12/2013Nefrolith bilateralEfusi pleura bilateralKista ginjal kiriLab 26/12/13Ur/Cr 27/1.0Lab 21/12/13CT/BT 7/2.3 ; Ur/Kr 35/1.1 ; alb 3.3Na/K/Cl 142/3.3/116 ; PT/APTT 11.8/21.4WBC 29.56 : RBC 4.12; HGB 11; HCT 33.5;PLT 86CT Abd atas/vawah 18/12/13Cholestatik intra/ekstrahepatik dgn pancreatitis akut DD/ Massa caput pancreas, Susp Tu. Metastasis, Splenomegaly, Hidroureter

- IVFD RL: D5 28tpm- Ceftriaxon 1 gr/12

jm- Ardium tab 2-2-2

6


LONTARA 2 DIGESTIVE KAMAR 1 (Eka Novryanti 085341171040)

19 Bed 1 Muh. Alwi KadirTL. 6/6/1977( 36 tahun )MRS.9/12/2013RM. 639544JAMKESMAS

Dr.dr.Ibrahim Labeda,SpB-KBD

Fistel peritoneal cutaneus + susp tumor paru

Hasil kultur dan sensitivitasResisten gram (+) dan gram (-) = BenzylpenisilinResisten gram (+)= oxacylinLab 29/12/2013WBC: 8,5 RBC:5,43 HGB:16,1 HCT:47,3 PLT: 323 LED jam I:11 jam II:27 CT/BT:9’00/3’00 PT/APTT:11,1/29,6 Na/Ca/Cl: 136/4,3/111 GDS:101 Ur/Cr:26/1,04 SGOT/SGPT: 39/35 Albumin:4,0 INR:0,93Foto thorax 29/12/2013Kesan: tuberculoma DD/ tumor paru dextraEchocardiogram 29/12/2013Kesan: -fungsi sistolik LV baik, EF 73% -Disfungsi diastolicCT thorax 25/12/2013Kesan: -nodul soliter paru kanan suspek tumor paru primer DD/tuberculoma -Fistel peritoneal cutaneus

-Ciprofloxacin (2x500)-Metronidazole (3x500)

20 K1B2 JupriRM 641439Tgl lahir 01/12/1971

Tu. Abdomen USG Abdomen 11/12/2013-Massa paraumbilikal sugestif mesenterial- Hepatoma lobus kanan DD/ metastasis hepar- Pelvocalyectasis DCT-scan 17/12/2013- Massa hepar susp hepatoma dengan

lesi satelitColon in loop 16/12/2013- Colon in loop normal- Sesuai gambaran extraluminerKimia darahGDS 166, ur/cr 14/1,9, alb 3,9, prot tot 8,5, WBC 8,6, RBC 4,38, HGB 13,9, PLT 203

As. Mefenamat 500 mg 3x1

21 K1B3 Ongky Arianto28/10/1990JamkesmasMRS 25/12/2013RM: 643482Dr.dr.Ronald E.L Sp.B;KBD

Anemia, Hematemesis + melena ec ca recti

Lab ( 28 -12-13) WBC13.73 Rbc 3.21 Hb 8.7 HCT 26.4 PLT 465

Lab 25/12/2013WBC 19,46; RBC 2,35; HGB 6,6; HCT 19,7; PLT 338; CT 7’30”; BT 3’; PT 10,7; INR 0,90; apt <15 control 23,3; GDS 76; UR/CR 76/27; GOT/GPT 24/29; Na 123; K 3,1; Cl 87Usg Abdomen 24/12/2013

IVFD RL 28 tpmCeftriaxone/12j/ivRanitidin/8j/ivOMZ/12j/ivCoctail drips/12jTransfusi PRC 2 bag

7


Tidak tampak kelainan pada organ solid intraabdominal kecuali loop-loop usus yang dilatasi.

22 K1B4 Tn. SukriTL=31/12/1958 (54 thn)RM 64 19 57MRS 14/12/13UMUMDr.dr.Ronald.L.E.Sp.B-KBD

POH 6 Drainage billier ec susp tumor caput pankreas

- Lab ( 21 -12-13) CT 7.0 BT 2.0 PT 12.1 APTT 34.4 GDS 205 Ur/Kr 23/0.5 Bil.total 26.3 Bil. Direct 18.6 SGOT 56 SGPT 65 Alb 2.6 Na/K/Cl 134/3.5/114

- Imunoserologi Ca 19-9: 1211.62

CT Abdomen tanpa kontras (16-12-13)Kolestatik intra dan ekstrahepatik ec suspek stenosis distal CBDSludge GBEfusi pleura bilateral

- Lab (14-12-13) CT/BT 3’30”/8’30”, PT/APTT 27.5/54.9 GDS 98 Ur/Cr 30/0.5 Bil total 24.09 Bil direk 18.80 GOT/GPT60/60 prot.total 6.1 Albumin 2.9 Na/K/Cl 130/3.8/112 HbsAg dan Anti HCV non reaktif

- Lab (17-12-13) WBC 9.89 RBC 3.73 HGB 11.1 HCT 31.1 PLT 210

- USG Abdomen (14-12-13) - Cholestatik intra dan ekstrahepatik

dengan pankreatitis akut- Hypertrophy prostat

- IVFD NaCl:Aminofluid 1000:1000 28 tpm

- Ceftriaxone 1gr/12jam

- Metronidazole 0,5gr/8j/iv

- Ranitidin 1 amp/8jam/iv

- Ketorolac 1 amp/8jm/iv

- Vip albumin 3x2- Diet biasa- Mobilisasi duduk

ISOLASI (Kasma 085244846649)

23 Iso Bed 1

Ny.Asni09/05/1978RM 642270MRS 16/12/2013

Ikterus obstruksi susp choledocholithiasis + cholangitis

Tumor marker 23/12/2013CEA 3,51Ca 19.9 <3.00 (WNL)GDS 94, UR/CR 14/0,3, bil tot 16,2; bil direk 11,9; GoT/GPT 73/107; prot tot 4,3; Alb 2,7; Na 135; K 3,9; Cl 105; Darah rutin 19/12/2013WBC 19,65; RBC 3,75; HGB 10,4; PLT 248;PT 12,1 control 10,7INR 1,00; apt 19,1 control 23,5; CT 7’00”;

USG abd (27/12/13)- Kolestatik intrahepatik e.c susp.batu

pd duktus hepatikus comunis DD/batu pd proximal CBC

- IVFD clinimix: RL:NaCl 1:1:1 28 tpm

- Levofloxacin 500mg/12j/ iv

- Metronidazole 0.5 mg/8j/ iv

- Vip alb 3x2 caps- Vit K amp/24jam- OMZ vial/24j/iv- CT-Scan abdomen

24 IsoBed 2

Ny. Kadek Sugiarti01-07-1976

Fistel enterocutaneus

Lab 26/12/2013CT 7’30”; BT 3; PT 12,2 control 10,2; INR 1,00; APTT 21,7 control 26,2; GDS

- Takar produksi fistel/24 j

- IVFD RL 28 tpm

8


RM 643556MRS 27/12/2013Dr.dr.Ibrahim Labeda Sp.B-KBD

105; ur/cr 5/0,2; prot total 4,4; Alb 2,4; Globulin 2.0; Na 143; K 3,66; Cl 104; WBC 6,67; RBC 4,92; HGB 12,0; HCT 35,9; PLT 818

- Ceftriaxone 1 gr/12j/iv

- Ranitidin amp/8j/iv

- Ketorolac amp/8j/iv

LONTARA 2 DIGESTIVE KAMAR 2 (Nila (089666366277) )

25 Kamar 2 bed 1

a. Nama :Rosmiatib. pahec. 32 Tahund. Medis : 639238e. MRS : 4-12-2013

dr. Ronal R Sp.B KBD

POH 16 Eksplorasi CBD

Lab tanggal 16/12/13WBC 9,13 RBC 4,51 HGB 13,4 HCT 38,5 PLT 270 CT/BT 8’00”/3’00” GOT/GPT 15/10 Bilirubin total 0,65, bil.direct 0,29, albumin 3,5, Na/K/Cl 138/3,68/108Lab tgl 03/12/13SGOT 23SGPT 44 gamma 166 Lab tgl 28/11/13Bilirubin total 1,16, bil.direct 0,74, alk phosphatase 796,albumin 4,1, ur/cr 11/0,79,Na/K/Cl 137/4,0/101Lab tanggal 26/11/13WBC 5,4 RBC 4,69 HGB 14,1 HCT 40,8 PLT 348 CT/BT 8’00”/3’00” GOT/GPT 368/322USG tgl 26/11/13Kolestatik intra dan ekstra hepatik ec batu CBD ,CholelithCT Scan tgl 28/11/13 Cholestatic intra dan ekstrahepatic ec batu distal CBDpneumobiliaCholelith dengan cholecystitisFoto Thorax AP/PA tgl 29/11/2013Tidak Tampak kelainan radiologic pada foto thorax ini.

Cefadroxyl 2x500Pct 3x500Diet lunakGV+Rawat LukaAff hecting

26 Kamar 2 Bed 2

Ny. Wa Saku64001301/07/1958MRS 09/12/13JKM

dr. Warsinggih, Sp.B-KBD

Tu. Abdomensusp. Tumor Lien.

MSCT Scan Abdomen dengan kontras 5/12/2013- Massa di lien yang kesan mendesak

dan menyempitkan lumen gaster disertai perlengketan

- Abses hepar- Kista adneksa kiriEcho 5/12/2013- Fungsi sistolik LV cukup, EF 59%- LVH (+)- MR mild, AR moderateFoto polos abdomen 2/12/2013Soft tissue mass region hipochondrium kiriUSG abdomen bawah 2/12/2013Massa hypochondrium kiri susp tumor gaster mesenkimal DD/ LimfomaLab 2/12/2013

Asam mefenamat 3x500Ranitidin 2x150Terapi sesuai Ts. GH. Operasi Senin 30/12/2013

9


WBC 13,49; RBC 4,24; HGB 11,7; HCT 34,6; PLT 403; PT/APTT 14,5/26; INR 1,2; CT/BT 8’/3’; Na/K/Cl 139/4,0/105; GDS 140; Bil. Tot 0,90; Bil. Direk 0,24; As. Urat 4,7; GOT/GPT 22/12; Alb 3,7; prot. total 7,6; alkali phospat 80; Ur/Cr 33/0,79;HbsAg non reactive

27 Kamar 2 bed 3

Ny. Isapiah01-11-2013RM 638585JamkesdaMRS 21-12-2013Dr.dr. Ibrahim Labeda Sp.B KBD

Ca Recti 1/3 distal Pem. LGIE 01-11-2013Hemoroid eksternaTumor rectum susp. MalignaEchocardiogram Report Fungsi sistolik & diastolik LV baik, EF 68%USG abdomen tgl 22-11-2013Sesuai massa rectumTidak tampak tanda kelainan radiologik pada foto thotax ini.CT-Scan Abdomen tgl 25-11-2013Massa RectiLab tgl 22-11-2013WBC= 4,5 RBC= 3,71 HGB= 10.5 HCT= 30,9 PLT= 338. CT/BT= 8‘00/3’00 PT= 13,2 control 10,5. APTT= 23,3 control 22,9 INR= 1.10 GDS= 99 Ur/Cr= 20/0,9 SGOT/SGPT= 16/22 Alb= 4,1 Na/K/Cl= 124/3,8/105 CEA = 0,59 HbsAg= (-) Anti HCV= (-).

IVFD RL :D5% 1:1 28 TpmRanitidine amp/8j/ivKetorolac 30mg kp/8j/ivOBH Syrr 3x1 cthBisolvon Syr 3x1 cthRencana Colon In Loop

28 Kamar 2 bed 4

Husniati4o thn640683Mrs 10/12/13Dr. Ronald, Sp.B KBD

Tumor abdomen susp lymphoma

Lab 10/12/13Wbc 12,37 RBc 5,21 HB 13 HCT 39,2 PLT 385 USG abdomen 10/12/13Massa regio umbilical yang meluas ke inguinal kiri dengan gambaran lymphomaHydronephoris S

Tramadol amp/8j/ivDiet biasa

H. Parade : Rencana Laparotomi + Biopsi

LONTARA 2 DIGESTIVE KAMAR 3( Rahma 085218205466)

29 Bed 1 M. sarif 01/01/88613562Mrs 17/12/13Dr. dr. Ibrahim Sp.B KBD

Post colostomy X-ray 12/12/13BNOTidak tampak kelainan pada foto iniLopografiTidak tampak kelainan pada foto iniColon inLoopKaliber lumen kolon descendens sigmoid tampak mengecil

Diet biasaSpooling NaCL 0,9% pagi-soreKlisma yall/HariTunggu Status LamaH. Parade : Pro tutup colostomy

30 Bed 2 Rezky01-05-1982RM 642973MRS 21-12-2013JKMDr.dr.Ibrahim L SpB

D/ Post Laparatomi e.c Perforasi Gaster

Lab. Tgl 21-12-2013WBC= 14,54 RBC= 3,73 HGB= 8,8 HCT= 27,0 PLT= 560CT/BT= 7’00”/2’00” PT= 13,4 control 10,9. APTT= 225 control 23,9 INR= 1.095 GDS= 11,6 Ur/Cr=

IVFD RL:D5%:Climmix= 1:1:1Ceftriaxone 1 gr/8j/ivMinum Bebas+ makan Bubur

10


KBD 52/1,0 SGOT/SGPT= 78/53 Prot.total= 6,7 Alb= 2,2. Na/K/Cl= 152/4,1/122. HbsAg= (-), Anti HCV=(-).USG Abdomen atas tgl 21-12-2013Tidak tampak kelainan pada organ-organ abdomen yang terscan.

Omeprazole Vial/24J/IVUsul Aff cupCek Lab Kultur & sensitivitas Pus Luka OPMobilisasi dudukGV + Rawat LukaBoleh Rawat Jalan

31 Bed 3 La Madong31-12-1954RM: 643477MRS: 25-12-2013

D/ Splenomegaly

Lab tgl 25-12-2013WBC= 6,26 RBC= 3,25 HGB= 7,6 HCT= 26,1. PLT= 62. Prot.Total= 3,4 Globulin= 0,3 Bil.Total= 0,61 Bil.Direk= 0,25 CT/BT= 7’00”/3’00” PT= 15,1 control 10,3 APTT= 37,5 control 23,3 INR= 1,283 GDS= 92 Ur/Cr= 52/1,3 SGOT/SGPT= 33/33. Na/K/Cl= 136/3,7/136. Alb=2,2 HbsAg= (-) Anti HCV= (-)USG Abdomen tgl 25-12-2013Splenomegaly

IVFD RL 28 tpmCeftriaxone 1 gr/12j/ivRanitidine 50 mg/8j/ivMetronidazole 0,5gr/8j/ivTunggu hsil CT-scan Abdomen, evaluasi ADT.

32 Bed 4 Mardan1/12/1986642249MRS: 22/12-2013

Dr.dr.Ronald. E. Lusikooy Sp.B. B-KBD

Hematochecia e.c Colitis Ulseratif

Lab. 16-12-2013WBC= 9,19. RBC= 3,92. HGB= 7,7. HCT= 25,5 PLT= 435. CT/BT= 8’00”/3’00”. PT= 14,7 control 10,7. APTT= 30,1 control23,5. INR= 1,1 GDS= 64. Ur/Cr= 14/2,0. SGOT/SGPT= 27/27 Prot.total= 4,07. Alb= 1,7 Na/K/Cl= 135/4,42/116. HBsAG= (-). Anti HCV=(-) Lab tgl 18-12-2013WBC= 9,49 RBC= 4,43 HGB= 10,2 HCT= 31,7 PLT= 361. USG Abdomen Atas+Bawah tgl 18-12-2013Hepatomegaly

IVFD RL : Aminofluid 1000 1;1 28 tpmCeftriaxone 1 gr/12j/ivKetorolac amp/8j/ivRanitidine amp/8j/ivMetronidazole 0,5gr/8j/ivOBH Syr 3x1 cthTunggu Jadwal Kolonoskopi dan Endoskopi dari TS GEH

LONTARA 2 Bedah Digestif KAMAR 10(Ryan Kanzul Arasy 082369420682)

33 L2 diges K10Bed 1

Ny. Hadiah1/10/1960MRS: 18/11/2013 638001Jamkesmas

Dr. dr. Ibrahim Labeda, Sp.B-KBD

Tumor hepar +post op hari 6 laparatomy eksplorasi + debulking tumor

Lab 26/12/2013WBC 13,19; RBC 2,38; HB 6,4; HCT 20,1; PLT 341; Na/K/Cl 136/3,77/113; GDS 98; Ur/Kr 27/0,6; GOT/GPT 6/5; Alb 2,0; prot total 4,3Lab 23/12/2013WBC 8,8; RBC 4,37; HB 12,1; HCT 34,2; PLT 411; Alb 2,5; prot total 5,7Lab 19/12/2013WBC 8,25; RBC 3,69; HB 9,8; HCT 30,3; PLT 259; C/BT 8’/3’ PT/APTT

IVFD RL : D5: NaCl 0,9% = 28 TpmCeftriakson 1gr/12 jRanitidin 1amp/8 jam/ivFarmadol botol/iv/drips (jika demam)Transfusi PRC 2 bag premedikasi transfusi : Dexamethasone 1 amp/IV

11


11,7/30,1; INR 1,0; Na/K/Cl 140/3,3/110; GDS 125; Ur/Kr 24/0,7; GOT/GPT 15/8; Alb 2,7;Lab 16/12/2013WBC 8,49; RBC 3,52; HB 9,3; HCT 28,3; PLT 210Lab 12/12/13WBC 5,7; RBC 2,66; HGB 6,9; HCT 20,6; PLT 296; Na/K/Cl 141/3,2/108;CT/BT 8’/3’; PT/APTT 14,1/316; GDS 74; Ur/Kr 20/0,85 GOT/GPT 30/16 Prot. tot 5,0; albumin 2,3Lab 9/12/2013RBC 2,87; HGB 7,6; HCT 23,9; WBC 9,4; PLT 308;Lab 8/12/2013GOT/GPT 15/8; Albumin 1,8Na/K/Cl 137/3,5/115; CT /BT 8’/3’PT/APTT 13,7/31,1; GDS 108Ur/Kr 20/0,9;Lab 29 / 11 / 2013 WBC 6,4; RBC 2,95; HB 8,0; HCT 24,8; PLT 147;Lab 27/11/2013WBC 4,3; RBC 3,04; HGB 7,7; HCT 24,8; PLT 216USG Abd 26/11/2013Massa mesenterium berseptal disertai ascitesCholelithLab 23/11/2013WBC 4,90; RBC 3,35; HGB 8,6; HCT 26,4; PLT 349;Lab 21/11/2013RBC 2,26; HGB 6,3; HCT 20,4; PLT 268; WBC 5,0;Lab 20/11/2013RBC 1,96; HGB 4,3; HCT 34,7; PLT 260; WBC 4,3;Lab 18/11/2013WBC 4,36; RBC 1,46; HGB 2,6; HCT 10,3; PLT 213; CT/BT 8’/3’; PT/APTT 12,5/21,9; GDS 120; Ur/Cr 18/0,7; GOT/GPT 17/9; Na/K/Cl 140/4,0/113;PA 3/10/2013Cairan Kista:Mesotel Proliferatif dengan inflamasi (Cairan Peritonium)Kista Hemoragik (Cairan Kista)

Difhenidramin 1 amp/IMMobilisasi duduk

L2 diges Kamar10Bed 2

Hj. Jipa 1/1/1933 (80 thn)MRS 30/11/2013639479

Tumor Adnexa + ascites

Analisa cairan pleura 20-12-2013Warna:kuning; pH:8,0; rivalta:positif; LDH;411CT Scan Kepala 18/12/2013

IVFD RL : D5% : NaCl 0,9%=1:1:1= 28 tpmRanitidin 1amp/8jam/ivKetorolac jika nyeri

12


Jamkesmas

Dr. dr. Ronald E. Lusikooy, Sp.B-KBD

Infark cerebri bilateralLab 18/12/2013AFP 0,67; CEA 1,35; CA 125 2211,36; Beta HCG kuantitatif <2,00;Foto thorax AP 4/12/2013- Cardiomegaly- Atherosclerosis aorta- Bulging diafragma kanan (proses

intrahepatik?)USG Abd 2/12/2013- Massa kompleks adneksa- Efusi pleura bilateralLab 2/12/2013 RBC 4,90; HGB 13,5; HCT 42,1; PLT 250;Lab 30/11/2013SGPT 45; protein total 5,3; albumin 3,1; globulin 2,2; Na/K/Cl 136/4,0/112;CT Scan 29/11/2013- Massa kompleks adneksa- Efusi pleura bilateralLab 29/11/2013GDP 67;Lab 28/11/2013CT/BT 8’3’; PT/APTT 12,9/27; GDS 275; Ur/Kr 21/0,9; SGOT/SGPT 168/45; Alb 3,1; Prot tot 5,3; Glo 2,2; Na/K/Cl 136/4,0/112; HBsAg non reactiveUrine Rutin 28/11/2013Warna Kuning agak keruh, protein +3/>300 glukosa +2/250 blood +2/80

Terapi lain sesuai TS bag GH, Neuro, dan obgynTakar dan alirkan drain ascites/24jam

35 L2 diges K 10 bed 3

Asnat Hagemur 5/2/1959 (54 th)64290120-12-2013Jamkesmas

Dr. dr. Ronald E. Lusikooy, Sp.B-KBD

Tumor abdomen USG kandungan 21-12-2013Massa kompleks dominan kistik kesan massa adneksa kananLab 20-12-2013WBC 10,50; RBC 4,75; HGB 7,5; HCT 28,2; PLT 231; CT/BT 7’/3’; PT/APTT 13,7/23,8; GDS 126; Ur/Cr 26/0,6; GOT/GPT 17/14; Na/K/Cl 142/3,4/112; albumin 3,1USG abdomen Whole abdomen 20-12-2013Tidak jelas tampak tanda-tanda pneumoperitoneumSplenomegalyMassa adnexa kanan

AFF infus.Ganti obat oralNeurodex tablet 3x1Cefixim 2 x 100 mgLansoprazole 1 x 1

36 L2 diges K 10 bed 4

Ny. A. Nurleny11-10-1970RM: 606115jamkesda

POH 10 laparatomy eksplorasi ec Tumor Recti 1/3 distal

Lab tgl 20-12-2013WBC 23,05; RBC 4,83; HGB 11,1; HCT 34,9; PLT 481; PT/APTT 14,6/33,0; GDS 45; Ur/Cr 7/0,4; GOT/GPT 103/103; Na/K/Cl 130/4,1/107; albumin 2,3

RL :D5% :NaCl 0.9% :Aminofluid 1 :1 :1 :1 28 tpmMakan bebasMobilisasi dudukInj. Imepronem 1 gr/12

13


Lab tgl 20-12-2013CT/BT 8’/4’; PT/APTT 16,6/25,8; GDS 111; GOT/GPT 181/80; albumin 2,5Lab tgl 10-12-2013Feritin 1,60CEA 1659,61TIBC 30,7Lab tgl 07-12-2013GDP= 90Lab tgl 20-12-2013WBC= 8,7 RBC= 4.10 HGB= 9,7 HCT= 28,7 PLT= 411. GDS= 111 Ur/Cr= /0,41 SGOT/SGPT= 182/80 Alb= 2,5 As. Laktat= 55,5. CT/BT= 8’00”/4’00” PT= 16,6 control 12,1 APTT= 25,8 control 25,9 INR= 1,39 Na/K/Cl= 131/4,9/103. HBsAg= (-).

jam/IVKetorolac amp/8 jamPanzoprazol 40mg/24jam

37 L2 diges K 10Bed 5

Haramia1/7/1975 (38 thn)641950MRS 15/12/2013Jamkesmas

dr. Samuel Sampetoding, Sp.B-KBD, MARS

Cholestasis intrahepatik

Lab 28/12/2013GDS : 121; Bil. Total:15.3;Bil. Direk:13; Albumin: 1.6; Na: 144; K: 2.5; Cl:114Pem. Pre transfusi 19/12/2013Kesimpulan: incompatible pada minor dan autocontrolKesan : Ditemukan adanya antibodi yang couted pada sel darah merah pasien itu sendiri secara invivoSaran : tunda transfusi Lab 1 8 /12/2013 Ca 19-9 26,56; alkali phospat 114; CT Scan abdomen 18/12/2013- Splenomegaly- Meteorismus- Ascites Lab 14/12/2013WBC 9,82; RBC 2,09; HB 7,6; HCT 22,5; PLT 94;CT/BT 8’30”/3’30”; PT/APTT 22,6/51,6; INR 1,840; GDS 94; Ur/Kr 11/0,5; Bil. Total 11,38; Bil. Direk 9,33; GOT/GPT 107/42; Prot. total 9,3; Alb 1,3; Globulin 8,0; Na/K/Cl 134/3,1/117HBsAg/Anti HCV non reactive

IVFD NaCl 0,9%:RL28tpmInjeksi vit K 1amp/24jm/ivVip albumin 3x2 tabDrips Albumin 25 1 kolf/IV

Visite dr. Tantowi:Koreksi KaliumKonsul HOM

38 L2 digesK10 bed 6

Hj Jumriah1-7-1955 (58 th)642969MRS 21-12-2013Jamkesmas

Dr. dr. Ibrahim Labeda, Sp.B-KBD

Ca recti 1/3 distal +P.O. Mile’s procedure + prokemoterapi siklus V

BNO 3 PosisiSmall Bowell Obstruction

Lab 17-12-2013WBC 7,0 ; RBC 4,23; Hb:14,1; HCT 41,1; PLT 208; Na/K/Cl: 131/4,4/87; BT/CT: 3,00/8,00; PT 12,5 control 12,7; APTT 22,5 control 28,9

IVFD RL 20 tpmRanitidin 1 amp/8jam/IVCeftriakson 1gr/12jam/ivKetorolac amp/8j/ivMobilisasi dudukDiet Bubur

LONTARA 2 KAMAR 11 (Steven 085255536675)

14


39 Bed 1 Tn. Juhering1/7/1961640533MRS: 4/11/2013JKM

Dr. dr. Ibrahim Labeda, Sp.B KBD

POH 23drainage abcess scrotum+ Nekrotomi

POH 5Necrotomy + debridement

Lab 9/12/2013WBC 7.6 RBC 3.86 HGB 10.4 HCT 30.8 PLT 323 GDP 124 Alb 2.1 Kol. Total 103 HDL 17Lab 7/12/2013WBC:5,96 RBC:3,91 HGB:10,9 HCT:31,3 PLT:294 Ur/Cr:17/0,5 Alb:1,80 Globulin:4,15 CT/BT:9’30/3’30 PT/APTT:13,3/28,4 INR:1,095 GDS:183 SGOT/SGOT:57/33 Prot total:5,95Lab 4/12/2013WBC: 17,91 RBC: 4,05 HB: 11,2 PLT: 439 prot.total: 4,1 Alb: 1,9 Globulin: 1,9 CT/BT: 7’30/3’00 Ur/Cr: 22/0,6 GOT/GPT: 24/21 Na/K/Cl: 131/3,6/107 GDS: 110Foto thorax PA 4/12/2013Kesan:

- Bronchopneumonia bilateral- Cardiomegali- Limfadenopati DD/massa

mediastinum superior

- IVFD RL 24 tpm- Ceftriaxon

1gr/12jam/IV- Ketorolac

1amp/8jam/IV- Ranitidin

1amp/8jam/IV- Metronidazol

500mg/12jam/IV

40 Bed 2 Sujiono/ L/63 tahun01/07/1950(631732)MRS : 06/11/2013Penagihan

Dr. dr. Ronald E. L, Sp.B-KBD

D/ POH 23 laparatomi biopsyLimfoma maligna non Hodgkin

Lab 14/12/2013WBC 5.4 HGB 10.3 RBC 3.52 HCT 30.7 PLT 438Lab 12/12/2013WBC 3.7 RBC 3.52 HGB 10.3 HCT 29.8 PLT 3.58 Na/ K/Cl 140/ 3.5/ 100 GDS 93 Ur/ Cr 20/0.79 SGOT/SGPT 29/12 Alb 2.9Hasil PA 11/12/13Limfoma maligna non hodgkinLab 2/12/2013Albumin:3,4Lab 26/11/2013 WBC: 10,27 , HGB: 11,4 , PLT: 619, RBC: 3,92Lab 20/11/2013 CT 8, BT 3, PT 13,4, INR 1,11 APTT 33,2 Na 130 K 3,6, Cl 103 HbsAg non reactive Anti HCV non reactive, GDS 80, Ur 27 Cr 0,97, GOT 56, GPT 32, Albumin 2,5Lab 12/11/2013WBC 3,7 RBC 3,51 HGB 10,4 HCT 29,4 PLT 305 Na 134 K 3,8 Cl 105 GDS 84 Ur/Cr 15/0,8 SGOT/SGPT 20/5 Protein total 6,2 Alb 2,9 As.Urat 6,4 CT 8’ BT3’ PT/APTT12,8/26,4Lab 7/10/2013WBC 5,6 RBC 3,90 HB 10,9 HCT 32,6 PLT 379 CT 8’00” BT 3’00” PT 11,0

Alih rawat HOMNeurodex 2x1

15


APTT 27,6 CEA 1,01 GDS 90 ur 21 cr 0,9 GOT 21 GPT 6 Na/K/Cl 131/3,9/108Kolonoskopi 17/10/2013Massa tumor extraluminer infiltratif proktitis derajat sedangBiopsi 21/10/2013Epitel dengan displasia ringan dan radang kronik aktifUSG Abdomen (09/10/2013)Kesan : massa extraluminer dengan pembesaran KGB villi usus Colon Inloop (09/10/2013)Kesan : Tumor rectosigmoid dengan tanda-tanda obstruksi infiltratif CT-Scan Abdomen (09/10/2013)Kesan : Massa rectosigmoid yang infiltrasi ke jaringan di sekitarnya (DUKES C)Foto ThoraxCOR & Pulmo dalam batas normalOld Fracture 1/3 medial os clavicula dextra

41 Bed 3 Syarifuddin Rola31/12/1964639670MRS : 28/11/2013Konsul dari interna : 11/12/13

Dr. dr. Ronald Lusikoy Sp.B KBD

POH 11laparascopy drainase abses konversi laparatomi

PA 19/12/2013Kesimpulan : Jaringan nekrotik dengan peradangan supuratif (sesuai untuk abses)Foto thorax PA 15/12/2013- Efusi pleura dextra- Dilatatio et elongatio aortae- Atherosclerosis aortae- Emphysema subcutisLab 11/12/13Bilirubin total : 0,63 bilirubin direk : 0,08 albumin : 2,3 WBC : 10,33 RBC : 3,97 HGB : 11,2 HCT : 32,6 PLT : 512Lab 4/12/13AFP : 1,83 CEA : 1,62 alkali fosfatase : 426 gamma GT : 202Lab 2/12/13GDS : 60Lab 30/11/13CT : 7’00 BT: 3’00 PT : 15,7 APTT : 34,1 Albumin : 2,4 Na : 144 K : 3,6 Cl : 114Lab 29/11/13Ureum : 39 kreatinin : 0,7 GOT : 83 GPT : 88 protein total : 5,4USG Abdomen 3/12/2013-Hepatomegali dengan massa hepar susp. HCC dd/ abses hepar-multikistik ginjal bilateralCT Scan Abdomen 3/12/13- Multiple abses hepar

- Cefadroxyl 2x500mg- Metronidazol 500mg

3x1- Ranitidin 3x1- Asam mefenamat

3x500mg- GV luka/hari

16


- Kista ginjal kiriEfusi pleura

42 Bed 4 Hasjun Laki-lakiRM 633836Tgl.lahir 1-6-1970 33 thnMRS 23/10/2013JAMKESMAS

Dr. dr. Ibrahim Labeda, SpB-KBD

POH 25laparatomi eksplorasi miles’ procedure ec karsinoma anorektal

POH 5 rekonstruksi anus

Lab 23/12/2013GDS:85 Ur/Cr:17/0,55 As.urat:4,8 SGOT/SGPT:14/18 Alb:3,0 PT/APTT:12,9/11,9 Na/K/Cl:131/3,6/96 CT/BT:8’30/2’30Tumor marker 23/12/2013CEA:1,99Lab 12/12/2013WBC 6.4 RBC 3.37 HGB 9.7 HCT 28.3 PLT 432Lab 2/12/2013GDS: 93 Ur/Cr: 21/0,7 GOT/GPT: 18/12 Na/K/Cl: 135/3,7/106 HBsAg non reactive WBC: 6,17 RBC:4,29 HB: 12,8 PLT: 250Lab 18/11/2013WBC 15,91 RBC 4,15 HGB 12,4 HCT 34,5 PLT 433Lab 16/11/2013Ureum 13 kreatinin 0,5 GOT/GPT 19/17 Prot.total 4,9 Albumin 2,9 Globulin 2,0 Na/K/Cl 132/3,7/98 CT/BT 8”/2’30” PT/APTT 10,9/27,0 GDS 116Lab 16/11/2013WBC 14,12 RBC 4,03 HGB 11,8 HCT 32,7 PLT 400Lab 8/11/2013Na 136 K 4,0 Cl 96 GDS 120 Ur 10 Cr 0,5 GOT 26 GPT 23 WBC 12,38 RBC 4,40 HGB 12,9 PLT 390Lab 4/11/2013CEA : 1,95Lab 31/10/2013WBC 9,2 RBC 4,48 HB 13 HCT 38,2 PLT 404PA 1/11/2013Adenocarcinoma differensiasi sedangLab 23/10/2013WBC : 7,03,RBC;4,35 HB:12,7 HCT :36,0 PLT;423+ CT;7’00 BT; 2’30 PT;9,7 APTT:26,2 GDS:96 UR; 17 CR; 0,5 Na; 139 k; 3,6 cl;100HBsAg non reactive, anti HCV non reactiveFoto thorax PA/AP 23/10/2013KP dextra aktifTidak tampak tanda-tanda metastasis pada foto thorax ini

Cefadroxyl 500mg 2x1Ranitidin 3x1Asam mefenamat 3x500mg

43 Bed 5 Tn. Herman Romady25/4/1987641907

-Laserasi colon descenden

-Suspek trauma

CT Scan Abdomen 17/12/2013Kesan:

- Organ intraabdominal yang

Aff infuseCefadroxyl 2x500mgMetronidazol 3x500mg

17


14/12/2013Umum


ureter (S) POH 22 laparotomi eksplorasi

terscan dalam batas normal- Efusi pleura bilateral

Lab 14/12/2013WBC 11.59 RBC 3.83 HGB 11.3 HCT 32.7 PLT 264 GDS 80 Ur/Cr 24/0.6 SGOT SGPT 65/46 Alb 2.2 USG Abdomen (14/12/2013)Efusi pleura minimal bilateral

Ranitidin 3x1Asam mefenamat 3x500mg

44 Bed 6 Tn. Abdul RahmanL: 1/7/1971MRS: 14/12/2013RM: 641892JKM


Ileus obstruktif totalPost op10 laparotomy+ colostomy

Tumor marker 23/12/2013CEA: 19,17PA 18/12/2013Kesimpulan:

- Signet ring cell carcinoma recti- Kelenjar getah bening

mesentrium dengan sinus histiositosis

Lab 13/12/2013WBC 13.97 RBC 4.64 HGB 12.2 HCT 35.7 PLT 455 SGOT/SGPT 12/9 Alb 3.3 Na/K/Cl 140/3.8/108 CT/BT 8/3 PT/APTT 11.6/20/7 GDS 111 Ur/Cr 69/1.2

Cefadroxyl 2x500mgRanitidin 2x1Asam mefenamat 3x500mgXeloda 2x2

LONTARA 2 ONKOLOGI (Yaya Soraya Irnanda 085239795504)

LONTARA 2 UROLOGI (Yaya Soraya Irnanda 085239795504)

45 L2 uro Km 10 bed 3

Tiro Tompo14/9/1990 (23 th)641845MRS 13/12/2013Umum

LP: 116 cm

Tumor abdomen + seminoma testis

Lab 17/12/2013LDH 438; AFP 1,02; beta HCG kuantitatif <2,00Foto thorax PA 14/12/2013Efusi pleura sinistraUSG Abdomen 14/12/13-Susp tumor metastasis ke hepar-Lymphadenopathy-Ascites dan efusi pleura sinistraLab 13/12/2013RBC 4,65; HB 12,5; HCT 38,6; PLT 362; WBC 14,7;CT/BT 6’/2’30”; PT/APTT 12,7/25,7; INR 1,095; GDS 121; Ur/Kr 12/0,8; GOT/GPT 27/10; Protein tot 6,3; Alb 3,1; Na/K/Cl 142/3,9/106;

Terapi sesuai TS urologi Laxadine syr 3x1 cthDiet tinggi seratAwasi tanda – tanda akut abdomen

46 L2 uroKamar 12 bed 3

Rais Rahim,Ir9-2-1969 (44 th)642981MRS 21-12-2013JKD

-Melena ec susp gastritis erosiva-cholesistholithiasis-nefrolithiasis bilateral

Lab 23/12/2013RBC 2,94; HB 8,0; HCT 24,4; PLT 442; WBC 17,46CT/BT 7’30’’/2’30”; PT/APTT 11,3/25,8; INR 0,905; GDS 91; Ur/Kr 31/1,6; GOT/GPT 13/15; Protein tot 6,1; Alb 3,6; bil total 0,52 ; bil direct0,11 ; Na/K/Cl 142/3,7/110; hBsAg/antiHCV non reaktiv

Konsul ke bagian GEHEvaluasi tukak pepticR/gastritis kronikCek DR, Bil Direk, Indirek

18


LONTARA 2 ORTHOPEDY(Yaya Soraya Irnanda 085239795504)

LONTARA 3 MATA (Steven 085255536675)

LONTARA 3 BEDAH THT(Steven 085255536675)

LONTARA 3 SARAF(Steven 085255536675)

LONTARA 3 KUL-KEL(Steven 085255536675)47 L3

K1B4SemangMRS:27/12/2013RM:642453TL:1/12/2013Jamkesmas

Tumor anal CT scan abdomen tanpa kontras 23/12/2013Kesan:

- Tidak tampak massa pada lumen rectum

- Lyhmphadenophaty bilateralColon In Loop 23/12/2013Kesan: Suspek pendesakan hemorrhoid externa DD/massa rectum distalFoto thorax PA 18/12/2013Kesan:

- Bronchitis kronik- Bronchiectasis

Lab 18/12/2013CEA:15,63 WBC:5,0 RBC:4,48 HGB:11,6 HCT:33,3 PLT:416 PT/APTT:12,6/25,7 INR:1,05 Prot total:7,6 Alb:3,7 Glob:3,9 SGOT/SGPT:29/22 Alkali phospat:77 Bil.total:0,31 Bil.direk:0,10 GDS:98 Na/K/Cl:136/4,2/110 Ur/Cr:29/0,95

48. L3K3B1

Herlina BoriMRS: 21/12/2013TL:6/10/1972RM:217534Askes

Hernia InsisionalLab 22/12/2013WBC:13,82 RBC:4,58 HGB:13,9 HCT:38,5 PLT:259 CT/BT:8’00/3’00 PT/APTT:11,3/21,4 INR:0,9 Na/K/Cl:142/4,1/113 GDS:106 Ur/Cr:29/0,7 SGOT/SGPT:24/43 Alb:4,1USG Lower Abdomen 22/12/2013Kesan:

- Defek dinding abdomen region suprailiaka kanan dengan herniasi loop-loop usus

- Organ-organ abdomen lain yang terscan dalam batas normal

Thorax AP 22/12/2013Kesan:

- Pulmo normal- Cardiomegaly dengan dilatation

aortae

Aff infuseGanti oralNeurodex tab 2x1Asam mefenamat tab (kp)

LONTARA 4 GINEKOLOGI (Eka Novryanti 085341171040)

19


50 Kamar 3 Bed 6

PoliatiP/01-02-1963(50 tahun)RM 632917MRS 07/11/2013Jamkesmas

Post op drainase ascites

KholelithiasisKista heparKista MesenteriumPost drainage asites

POH 6 unroofing kista

Lab 16/12/13PT/APTT 13.1/25.0INR 1.095 GDS 97 Ur/Cr13/0,7 GOT/GPT 23/5 WBC 8.28 RBC4.50 HB 11.4 HCT 36.0 PLT 495MSCT Whole Abdomen Non-Kontras (12/12/13)Kista mesenteriumKista heparCholelithAscites dan efusi pleura blateralFoto thorax (111/12/13)Efusi pleura bilateral (dibandingkan foto lama tanggal 19/12/13 ada perbaikan)USG (09/12/13)Massa kompleks ovarium kiri dengan ascites dan pleura bilateralKista lobus kiri heparCholelithiasisMassa kistik berseptasi ekstra luminal region hipocondriumkiri.Lab 02/12/2013 Albumin 2,029/11/2013WBC 7,29 RBC 3,67 HGB 9,0 HCT 28,6 PLT 39224/11/2013Albumin 7,0 WBC 7,29 RBC 3,67 HGB 9,0 HCT 28,6 PLT 392Lab 15/11/2013WBC 5,92 RBC 3,24 HGB 7,7 HCT 24,1 PLT 413 CT/BT 8’00/3’00 Ur/Cr 22/0,9 GOT/GPT 23/14 Albumin 2,2Lab 23/10/2013CA125 3581.99CT AbdomenMassa ovarium kiriKista MesenteriumKista heparCholelithAsitesEfusi pleura dextraLab 17/10/2013WBC 5,4 RBC 4,76 HB 10,9 PLT 557 Na 141 K 3,9 Cl 109 GDS 111 Ur 21 Cr 1,0 GOT 19 GPT 6 Alb 3,3 CT 8 BT 3 PT 12,4 APTT 33USG Abdomen 18/10/2013Massa kompleks ovarium kiriKista heparCholelithAsites dan efusi pleura kanan

IVFD RL ; D5=2:1Cefotaxim/12 jamMetronidazole 0,5 mg/8jKetorolac amp/8jRanitidine amp/8jAs.traneksamat /8jTerapi sesuai TS obginTunggu jadwal operasi

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51 Kamar 1 bed 2

Muhaira01/01/1976639683Tgl konsul 8/12/2013JKM

Tumor abdomen extraluminer

Lab ( 27 -12-13) WBC10.61 Rbc 4.47 Hb 11.7 HCT 36.5 PLT 532 Na/K/Cl 139/3.43/115

CT-scan Abdomen 05/12/2013Massa mesenterium dd/ massa

USG abdomenMassa kompleks adneksa yang menginfiltrasi diniding anteriorbuli-buli pelvocalyceal ginjal bilateral

Rencana operasi laparatomi eksplorasi + colostomy pada hari senin 30 Des 2013

52 Kamar 1 bed 3

Rahmatia5/12/1972638788JPSTggal konsul 8/12/2013

Post drainase ascites day 17

Lab ( 25 /12/13) Alb 2.2Lab (17/12/13)CT/BT 8’/2’30” PT/APTT 11.9/27.8 GDS 66 Ur/Cr 15/0.5 GOT/GPT 16/12 Albumin 1.9Hasil PA (11/12/13)Cervitis kronik non spesifikLab 06/12/2013GOT/GPT 19/7 ALB 3,4 WBC 5,9 RBC 5,30 HCT 41,1 PLT 458 HGB 13,6 PT/APTT 10,7/22,8 GDS Ur/Cr 44/0,8 CT/BT 8’00”/3’00”CT-scan abdomenKesan:-susp.massa periappendicular

Appendicolith-susp.massa adnexa kiri-asites dan efusi pleura dextra minimal

IVFD Nacl 0,9% 28 TPM-GV/2 hari-alirkan darah 100cc/jam

53 Kamar 5 bed 2

Nambi25/10/1969641178Tgl 11-12-2013JKM

Post drainase ascites day 14

Lab (17/12/13)Alb 2.1Lab (1 9 /12/13) WBC 6.28 RBC 4.42 Hb 10.8 PLT 439 HCT 34.1Foto thorax (16/12/13)Cardiomegaly dengan dilatation et elongatio disertai tanda-tanda bendungan paruUSG lower (16/12/13)Massa adnexa suspek malignancyAcites, Polib GBLab 1 0 /1 2 /2013 ALB 2, PT/APTT 11,0/21,2

GV/2 hari+rawat lukaTerapi lanjut sesuai Ts Obgin

54 Kmr 4 bed 4

Manusiwa Marthira16/21/51 (61 th)MRS 12/12/13RM 641625ASKES

POH 15drainase ascites

Lab (17/12/13)Alb 2.1Lab (1 9 /12/13) WBC 6.28 RBC 4.42 Hb 10.8 PLT 439 HCT 34.1Foto thorax AP (16/12/13)Cardiomegaly dg dilatation et elangatio disertai tanda2 mlignancyBendungan paru

Alirkan drain 100cc/jamGV/hari

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Elevasi kedua diafragmaMSCT (16/12/13)Massa complex adnexa dg ascites suspek malignancyLab(14/12/13)Albumin 3.0 WBC 6.02 RBC 3.32 Hb 9.2 HCT 29.2 PLT 413Lab (12/12/13)CT/BT=8’30”/2’30” GDS 107 Ur/Cr=44/0.8GOT/GPT=46/23

55 Kmr 5 bed 3

Kasmira10-11-1996 (17 th)MRS 3/12/2013RM 641882JKD

POH 9drainase ascites

Usg AbdomenHidronefrosis dextra, ascites, komponen massa tidak dapat dievaluasiLDH 700 U/LAFP ,0,50 Ca 125 22,60Darah RutinWBC 5,26, RBC 5,11, HGB 10,8, PLT 272 Alb 3.3

R/ IVFD NaCl0.9% 28 tpmCeftriaxone 1gr/12jm/ivRanitidin /8j/ivKetorolac amp/8j/ivMetronidazole 0,5 gr/8j/ivBisolvon syr 3x1 cthAlirkan drain 100cc/jamGv/hari

56 Kmr 2 bed 4

Rita31-12-1968MRSTgl konsul 22/12/2013RM 642740Umum

NOK susp ganas + ascites

Darah RutinWBC 5,78, RBC 4,61, HGB 12,8, PLT 281Kimia darahNa 139, K 4,9, Cl 110UR/CR 28/0,4, GOT/GPT 22/6

TIA 24 cmH2O

IC (Eka Novryanti 085341171040)

ICU (NILA 089666366277)

58 ICU bed 3

Bentar 10-12-1989643311MRS: 25-12-2013Jamkesda

D/ post op hr 1Relaparatomi explorasi ec pertitonitis generalisata ec ruptur buli-buli Intraperitoneal+ruptur hepar 5,6-8

USG ABDOMEN 25-12-2013Ruptur Buli-Buli dengan hemoperitoneumUretrografiEkstravasasi kontras ke intraperitoneum suspek ruptur buli-buliFraktur ramus superior et ramus inferior os pubis bilateral.Lab tgl 26-12-2013WBC= 9,17 RBC= 2.86 HGB= 8,3 HCT= 24,2 PLT= 61 PT= 14,6 control 10,2 APTT= 32,3 control 28,2 GDS= 110 Ur/Cr= 42/1,2 SGOT/SGPT= 245/317 Alb= 2,2 Na/K/Cl= 136/4,47/115 ALKALOSIS METABOLIK

Awasi TTV & Tanda Akut AbdomenInfus RL 2000/24jImipenem 1 gr/8j/ivMetronidazole 500mg kp/8j/ivAs. Traneksamat 500mg/8J/IVTerapi sesuai di ICU

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59 ICUVIP 4

Tn. UsengRM 6438271/7/1935JAMKESMAS

Dr. Murny A. Rauf, Sp.B KBD

POH 1 Laparotomi eksplorasi ec. Perforasi Gaster (rupture Antrum Piloric)

28/12/2013AGDPh 7.42Lab. LengkapWBC 11.49 RBC 3.33 Hb 10.1 HCT 30.3 PLT 89 Ur/Cr 94/3.1 GOT/GPT 61/33PROT. Total 3.1HBsAG Reactive, Anti HCV non ReactiveCT 9’30” BT 3’30” PT 18.7/9.9 INR 1.5 APTT 33.6/29.0 GDS 50

IVFD RL 2000cc/hrMeropenem 1gr/8j/ivPantoprazole 40mg/24J/ivFarmadol 0.5gr/8J/IVAs. Traneksamat 500mg/8J/IVBalance CairanAwasi TTVTerapi lain sesuai TS Anestesi

PCC (Taufiq 087840568100)

60 Lt 3330

Tn Benito AbbasMRS: 24/11/13Ttl:29/11/1957Umum

Dr Mappincara, SpB-KBD

Post Ielostomy + RCC (D) Residif Hematemesis melena ec susp metastase usus

Lab 11/12/13WBC:14,7 RBC:3,55 Hb:10,2 HCT:30,0 PLT:291Lab 4/12/13WBC:10,2 RBC:2,53 Hb:7,6 HCT:22,5 PLT:408Lab (29/11/13)WBC:13,1 RBC:1,57 HB:4,8 HCT:14,6 PLT:344 PT/APTT:12,5/25,6 Alb:3,3 Na/K/Cl:137/4,0/115USG (25/11/13)Massa hipokondrium sinistraSplenomegalyKista ginjal kananThoraxCardiomegali dan dilatatio + atherosclerosis aorta

Terapi sesuai TS Urologi + InternaSpooling Colostomy

61 Lt 4411

Hasanuddin ArfahTtl:9/4/1974RM:633470MRS:29/11/13

Dr Ibrahim Labeda, SpB-KBD

Tumor esofagus 1/3 distal

MD 9/12/13Susp tu esofagus 1/3 distalMSCT ThoraxMassa esofagus 1/3 distalEndoskopi 2/12/13Mucositis ec jamur pada hipofaringLab 30/11/13CT/BT 2/6’30’’ PT/APTT:10,9/28 GDS:102 Ur/Cr:30/10,3 GOT/GPT:26/36 Protot:7,9 Alb:5,1 Na/K/Cl:146/4,3/106 WBC:7,5 RBC:5,1 Hb:15,8 HCT:45,2 PLT:276PA 18-12-13Peradangan kronik non-spesifik pada antrium

RL 24 tpmCefttriaxone 1gr/12jRanitidne amp/8jEndoscopy Lepper + Biopsi

62 Lt 3312

Tn. A. SafriTtl : 31/12/63)RM : 618938

Dr.dr. Ronald Lusikooy, Sp.B-KBD

Tumor Abdomen susp. Aneurisma aorta + efusi pleura (s)

LAB 18-12-13RBC 3,5 HCT 28,4 PLT 469 WBC 11,7

Terapi lanjut sesai TS BTKV

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63 Lt 4407

AnniTtl:31/12/1923RM614827MRS:10/12/13

Cholecistitis LabCT/BT:2/8 PT/APTT:12,9/20,8 GDS:131 Ur/Cr:31/1,1 GOT/GPT:30/24 AFP:1,18 CEA: 81,3 Ca 19-9 >500Na 132 K 3,5 Cl 102 As. Urat 3,3 Colesterol Tot 139, HDL 5 LDL 87 Tgd 233 as.urat 3.3Foto ThoraxLesi nodul soliter pada parabronchial dextra suspek Tu.paru DCardiomegali + dilatatio aortaeAtherosclerosis aorta

Terapi lanjut sesuai TS interna

RSUH (Taufiq Akbar 087840568100)

64 RSUH lt4 412

Tb AsriMRS: 22/11/13Ttl: RM: 016130

Dr dr Warsinggih, SpB K-BD

Ikterus Ob sec susp Ca Pankreas

Lab (7/12/13)WBC: 16,48 RBC:3,79 Hb:9,9 HCT:30,9 PLT:544Lab (2/12/13)GOT/GPT:59/40; Gamma GT:63,7 ALP:258,4 Bil Dir: 18,25; Biltot:42,7 GDS:92; Ur/Cr:28/0,6Lab (29/11/13)Na/k/Cl: 143/3,3/112MSCT Abd (26/11/13)Kolestatik intrahepatic dan ekstrahepatik disertai distended GB ec sugestif massa caput pancreasAscites dan efusi pleura bilateral

Optimalisasi KUInjeksi vit k 1 amp/12 jam/iv

65 RSUH lt4404

Hj MarthinaTtl:5/3/1959RM:016632MRS:10/12/13ASKESDr.dr. Warsinggih, SpB-KBD

POH VII CholisistekomiSusp batu CBD

Lab (17/12/13)WBC:13,98 RBC:3,81 Hb:10,5 HCT:32,2 PLT:480 Na/K/Cl:136/4,0/102 CT/BT 8/2 PT/APTT 12,9/33,4 GOT/GPT:72/92 ALP:535 Biltot:10,31 Bildir:6,24 Alb:2,9 GDS:146 Ur/Cr:24/0,5USG Abd (5/12/13) KolelitiasisBatu CBD menyebabkan kolestatik ductus biliaris intra dan ekstra hepatikMSCT abd (7/12/13)Choledocholithiasis distal disertai intra ekstra hepatik bile ectasisCholelithiasisNefrolith kiri pada pole bawahLab (8/12/13)GOT/GPT:98/107

- IVFD RL 28 tpm- Cefotaxim 1gr/12j- Metronidazole

500m/12j- Ranitidine amp/8j- Diet lunak- GV/hari

66 RSUHLt 4421

Zainal arifinTtl 5-9-1968010072

Post eksisi anorectum residif

Lab 21-12-13WBC : 7,4 RBC 4,37 HB 11,4 PLT 291

-ceftriaxon amp/12 jamMetronodazole 0,5 gram/12jamKetorolac amp/8jamRanitidine qmp/8jam

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67 RSUHLt 4423

Abdul HapidTtl:31/12/1959RM: 016701MRS:12/12/13Umum

Abses perianalDM tipe 2Trombositopeni pro evaluasi

Lab 13/12/13WBC:4,28 RBC:3,97 Hb:12,2 HCT:34,8 PLT:70 Na/K/Cl:132/4,4/100 CT/BT:7/2 PT/APTT:16,3/31,8 GOT/GPT:32/29 GDS:430 Ur/Cr:11/0,7Lab 21-12-13WBC : 3,5 PLT : 64 RBC : 3,53

- Broadced 1gr/8j/iv- Ranitidne amp/8j- Ketorolac amp/8j- Rawat luka

Konfirmasi interna trombosit 64ribu

68 RSUHLt 4403

Beddu AbbasTtl:10/10/1940Rm:016552MRS:08/12/13AskesDr.Warsinggih, SpB-KBD

Hipertrofi prostatHIL (s) irreponobilisHemoroid interna gr IIIPOH V

Lab 12/12/13WBC: 5,59 RBC:4,33 Hb:10,5 HCT:34,0 PLT:140 GOT/GPT: 238/262 Na/K/Cl:135/4,2/105 CT/BT:7/4 PT/APTT:21,1/34,5 GDS:110 Ur/Cr:80,5/1,5

- Perbaiki KU- Tunggu hasil HB

69 RSUH lt4422

Tn. SayogiTtl: 13/12/63Rm: 016737Mrs: 15/12/13Dr. Warsinggih, SpB-KBD

POH III Tu. Recti 1/3 Distal.

WBC 11,82 RBC 5,19 HB 15,7 HCT 45,8 PLT 414 Na 137 K 4,8 Cl 102 Sgot/Sgpt 66/45 Alb 4,1 Gds 79 Ur 21 Cr 0,8 HBSag (-) Anti Hcv (-)

Foto ThoraxKP Duplex lama aktif

- Optimalisasi KU- As. Mefenamat 3 x

500 mg- Ceftriaxone 1 gr/12

jam- Metronidazole 1 amp/

8 jam- Ketorolac 1 amp /

8jam- Ranitidin 1 amp / 8

jam

70 RSUH LT 4315

A.SafriTtl: 02/11/46Rm: 016870Mrs 19/12/13

Dr. warsinggih. Sp.B-KBD

Ikterus Obstruktif e.c susp. Batu CBD

LAB18-12-13WBC 12,77 RBC : 3,97 HB 11,1 PLT :265Tumor marker CA 19-9 >500u/mL

- Operasi hari ini

71 RSUHLT 4424

NurhayatiTtl: 01/01/70Rm: 016810Dr.dr Ibrahim Labeda, SpB-KBD

Tu. Abdomen e.c tu. mescenterium

Tgl 18/12/13WBC 36,74 RBC 2,45 HGB 7,5 HCT 23,1 Na 120, K 2,3 Cl 95 SGOT 36 SGPT 11 Alb 3,1 GDS 79 Ur 50 Cre 2,2 CT 9’00 BT 2’00 PT 12,8 APTT 36,1

CT Scan AbdomenMassa pada regio lumbalis dextra disertai pembesaran kelenjar paraaorta sugestive suatu Tu. Mescenterium

- Koreksi Kalium dalam 1 flacon dalam Nacl 100cc 12 tpm

72 RSUHLT 4425

RosnaTtl: 1-12-43Rm: 016904

Suspek Appendisitis akut

- Ranitidin 1g/8jam- Ceftriaxon 1gr/12jam- Metronodszloe

500mg/8jam

73 ICU Hj RosmiatiTtl : 31-12-1946RM : 016941Dr.dr Ibrahim Labeda, SpB-KBD

Tumur colon transversum suspek malignansi

Lab 20-12-13WBC:7,5 RBC:4,60 HB:11,3 PLT:296 Na:141 Cl:103 CT:6 BT:3 PT:14,7 APTT:35,1 GOT:21 GPT:15 GDS:109 Ur:39 Cr:0,8 HbsAg (-)

- Ranitidin 1g/8jam- Ceftriaxon 1gr/12jam

Metronodszloe 500mg/8jam

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75 RSUH Lt4416

SendanaTtl: 31-12-1960RM : 016468Dr. Warsinggih, SpB-KBD

Hemorroid Interna grII dan ekssternaUlseratif colitis

Rhodium tab 3x1

IRD Fitri (085299239369)

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Koran Digest Senin 30 Des

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