Koran Bedah Uro Minggu 3112013

KORAN BEDAH UROLOGI SENIN, 4 NOVEMBER 2013

LONTARA 2 UROLOGI KAMAR 1

1. Paulus woko20/8/1949 64 thnRM 627553MRS 2/10/2013JKMK1 B1

POH 11 open prostatektomi dan vesikolithotomi

Ranitidine 2 x 150 mgAmpicilin 3 x 500 mgMobilisasi jalanGV + Rawat Luka Vip Albumin 3 x 1 capDiet TKTPTakar drain/ 24jBladder training

Lab 12/10/2013CT 8, BT 2, PT 10,5, APTT 29,5,GDS 107, UR/K 41/1,8, GOT 21, GPT 10, ALB 4,3, WBC 8,92, RBC 4,84 , HB 12,5, HCT 37,7, MCV 77,9, MCH 258, MCHC 33,2 , PLT 309, HbsAg/ AntiHCV Non Reactive. NA/K/CL 142/4/107Elektrolit 7/10/2013Na/K/Cl: 149/3,0,102Lab 17/9/2013Asam urat 6,9 PSA 32,93 Urin rutin 17/9/13Sedimen lekosit >20, lekosit 500Radiologi 20/9/2013Thorax PA : kardiomegali dengan dilatatio et elongatio aortae (HHD)BNO IVP : urogram normal, vesicolith divertikel vesica urinariaLab 11/9/2013RBC 4,53 WBC 10,8 HGB 12 PLT 199 CT/BT 8/3 PT/APTT 11,3 / 29,8 GDS 129 Ur/ Cr 38/1,2 GOT/GPT 35/15 Na 137 K 3,6 Cl 106HbsAg / Anti HCV non reaktifUSG abdomen 11/9/2013Vesicolith + hipertrofi prostat TRUS 129,4TAUS 193,9Volume prostat 276ccEcho (26/09/13)Disfungsi sistolik dan diastolic, EF 47%La lv DILATASILvh +Inferior dan posterior hipokinetikMR ModerateAR Mild

2 Risal Parubak10-10-1980 33 thnMRS. 28-10-2013Askes wajibL2 K1 B2MR 634425

dr Muh Asykar P, Sp

Cystotomy ec stricture urethra

Ciprofloxacin 2x500mgAs. Mefenamat 3x500 mgRanitidine 2x150 mgMobilisasi jalan Rencana PER 4/11/13Kultur + sensitivitas tunggu hasil

Kultur urin tdk ada pertumbuhan bakteri anaerobLab: (27-10-2013)WBC 9,92 RBC 4,42 HGB 12 HCT 36,8 PLT 216GDS 170 UR/CR 16/0,8 GOT/GPT 20/19 Na/K/Cl 141/3,1/108Urin Rutin (27/10/13) Protein :75/++ blood 250/++++ leukosit 100/++ sedimen leukosit 5 sedimen Eritrosit: 5Foto pelvis + uretrocystografi (28/10/13)

1


U Striktur uretra pars posterior, extravasasi kontras ke rg extraperitonealThorax AP Gambaran BronkhitisUrin Rutin (29/10/13) Protein :25 blood 250/++++ leukosit 100/++ sedimen leukosit 5 sedimen Eritrosit: penuhLab 2/11/13 WBC: 7,39 RBC: 4,36 HGB: 12,7 HCT: 36,3 PLT: 274 GOT/GPT: 29/59 Alb: 3,4 Na/K/Cl: 139/3,7/109 GDS: 84 Ur/Ctr: 28/0,7 PT/APTT: 11,5/30,5 INR: 1,00 CT/BT: 8”00/3”00

3. Hasmuddin01/8/1980 33thnMRS. 18/10/2013JamkesmasRM : 631696K1B4

Dr. Asykar Sp U

POH 4 pyelolithotomi D ec batuUreteropelvic junction D

Aff infusAff kateterCefixime 2 x 200 mgPCT 3 x 1 Mobilisasi jalan

Lab (21/10/13)WBC 6, 7 HB 10,9 PLT 420 SGOT/SGPT 34/39 CT 8’00’’ BT 3’00’’GDS 74 PT/APTT 12,5(12,4)/28,9(26,5) UR/CR 24/0,6 PROTEIN TOTAL 8,7 ALB 3,4 AS.URAT 4,9Echo ( 16/10/13)-fungsi sitolik LV baik-LVH +-EF 78%IVP (11/10/13)Hydronefrosis grade II-III DextraNephrolite DextraPolos abdomen (8/10)Uretrolith dextraThorax (11/10) tidak tampak kelainanLab (7/10/13)CT 8, BT 3, PT 11,8 , APTT 29, PLT 568 , HB 10,6, GDS 80, UR/K 23/0,8 , GOT 50, GPT 70, WBC 10,1 , RBC 3,68 , MCH 29, MCHC 34,3 , MCV 84.Urine rutin (7/10/13)Blood 10 , leukosit 100 , sedimen leukosit 6 , sedimen eritrosit 100 , USG (21/10/13)Hydronefrosis dextraSimple renal cyst sinistraFOTO POLOS ABDOMEN (8/10/13)Ureterolith dextraKultur dan sensitivitas urin (21/10/13)Cara – manual, sample urine, tidak ada pertumbuhan bakteri aerob

4 Tn Abd Makmur13/03/1935

Tu. Buli-buliTu. Colli Anterior

Optimalisasi KUPasang infusIVFD NaCl 20 tts/mnt

Lab 22/10/13WBC= 11,9, RBC=4,52,HGB=88, HCT=28,9, PLT=533, GDS=70,

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RM: 633655MRS:30/10/13Msuk ltr 2 uro: 1/11/13JamkesmasK1B3

Transfusi PRC unitPerbarui labInj. Ceftriaxone 1 gr/12j/ovInj. Ranitidin 1 amp/8j/ivInj ketorolac 30 mg/8j/iv-> KP

Diet biasaRencana TUR-BT

Ur/Cr=49/1,9, GOT/GPT= 19/15, Alb=4,0, As.Urat=4,7, CT/BT=8’/3’, PT =12,3(12,2), APTT=23,5(25,4), HbsAg/antiHCV=negative, PSA=2,05Urin rutin 22/10/13Protein=75, sed.lekosit>20/lpb,sed.eritrosit.2/lpb, Echocardiografi 23/10/13-disfungsi diastolic LV-EF 75%Foto thorax PA 22/10/13Kesan; kardiomegali dgn dilatation aortaTidak tampak tanda2 metastasis pada foto thoraks iniUSG thyroid 24/10/13Kesan:massa thyroglossusUSG abdomen 23/10/13-massa buli-buli-Simple cyst ren dextraBNO 22/10/13-foto polos abdomen ini dlm batas normal kecuali fecal material yang banyakFNA 28/10/13-benign cyst


5. Andi Agung Ahmad4/7/1980634335MRS26/10/2013JKDK2B1

Post POH 9Laparotomi ExplorasiInternal Bleeding ec v. ictum penetransLaserasi colon transversumLaserasi ginjal (s) grd IIPO Renorafi sinistra hari ke 9 ec laserasi ginjal sinistra grade IILaserasi corpus gaster

Pemberian infus sesuai dari TS B DigestiveInjeksi sesuai dari ts B DigestiveRawat luka + GV/hari Mobilisasi dudukCek lab post transfusi

Lab 30/10/2013WBC 6,4 RBC 2,38 HGB 6,4 HCT 19,6 PLT 212Lab 26/10/2013WBC : 14,24, RBC : 4,08, HGB : 11,7, HCT : 33,5, PLT : 290, GDS : 166, Ur : 13, Kr : 0,8, Alb : 3,5, Na/K/Cl: 142/4,3/113, HBsAg : non reactive, Anti- HCV : non reactive

6. Saing1/7/1932630056MRS 21/10/2013ASKES

Ca. Buli-buliHipertrofi prostat Gr. III susp. MalignancyHidronefrosis

Rencana TUR – BT kalau perlu nefrostomySementara terapi sesuai dr GH u/

Lab 02/11/13WBC=5,62, RBC= 3,1, HGB=9,5, HCT=25,9, PLT= 105, Ur=166, Na/K/Cl=126/5,9/107Lab 28/10/2013GDS 79 ur/cr 139/6,6 GOT/GPT 20/8 prot. Total 6,6 alb 3,7 as.urat 9,5 Na/K/Cl 127/5,6/105 WBC

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K2B2 bilateralElektrolit Imbalans

penatalaksanaan HDTramadol lab 3 x 50Ranitidin rab 2 x 150Rencana TRUS/TAUS

8,6 RBC 2,69 HB 8 HCT 23,3 PLT 132Foto thorax (25/10/2013)cardiomegali dengan dilatasi aorta, tidak tampak metastasis pada foto torax ini.PA 16/9/13 Transtitional Cell Carcinoma (High Ggrade)Urinalisis 26/9/13Warna kuning muda, pH 5, BJ 1,015, protein 75, blood 250, leukosit 500, sedimen leukosit penuh, sedimen eritrosit 4, sedimen epitel sel 1PSA 23,57Lab 3/10/16WBC 7,1, RBC 2,79, HGB 8,4, HCT 25,5, PLT 173, Na/K/Cl 138/5,3/109, SGOT 15, SGPT 8, Alb 3,9, GDS 101, Ur 92 Kr 3,8, CT/BT 8’00/3’00, HbSAg Non reactive, Anti HCV Non reactiveCT Whole Abdomen 31/10/13Pembesaran prostat dengan kesan infiltrasi buli2 sugestif malignancyHidroureteronefrosis BilateralKista ginjal kananUsul: MSCT Scan abdomen dengan kontras

7. MassiriLaki-lakiRM 34833631/12/1924MRS19/10/13UmumK2B3

Tumor buli-buliSusp malignancyKista ginjal kananHidronefrosis Kiri

Rencana TUR – BT (4/11/13)Lengkapi persiapan operasi: Informed konsenLapor OKKonsul anastesiSiap darah 2 unit di bank darahPuasa 6 jam sblm OPAB profilaksis 1 jam sblm operasi

Lab 31/10/2013PSA 19,43 Alkali Fosfatase 84CT-Scan 29/10/13-massa buli-buli dengan perluasan ke sekitarnya disertai metastasis ke tulang, hidronefrosis kiri, kista ginjal kanan, efusi pleura bilateral, cholelith. Echo 25/10/2013Fungsi sistolik LV baik, LVH(+) LA dilatasi, MR moderate, AR Moderate, disfungsi sistolikUSG Abdomen Lower 19/10/13Massa buli-buli diserstai hidronefrosis bilateral terutama kiriLab 22/10/13RBC 4,221 HGB 11,4 HCT 35,4 MCV 84 MCH 27,0 PLT 350 MPV 7,3 GOT 13 GPT 9 NA 141 KAL 3,86 KLORIDA 113 HBsAg Non ractive, CT/BT 8’00/2’30 PT/INR 12,0/1,O0 APTT 27,2 GDS 100 UREUM 61 kreatinin 1,60Urin Rutin 19/10/13Warna merah, ph 7, protein 500/+++, blood 250/+++, lekosit 10, sedimen epitel sel 4-5, protein neg, glukosa neg


8. Nurjannah15/10/195954 thnMRS 9/10/2013RM 631207

Nefrolithiasis (D)

Ciprofloxacin 2x500mgAsam Mefenamat 3x500mgVIP albumin

Hasil elektrolit darah 11-10-2013Na 143 K 4,4 CL 109Lab 3/10/2013WBC 6,1 RBC 4,26 HGB 11,8 HCT 35,6 PLT 264 PT 11,0 c 12,4 INR 0,8 APTT 29,1 c 25,6 GDS 90 Ur/Cr 26/0,7 GOT/GPT 20/12 As urat 4,6 CT 8’00”

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ASKESL2K3B1

3x2 tab Rencana Extended pyelolitotomi (D)RENCANA OPERASI (Senin, 28 /10/2013)

BT 3’00” HBsAg (-)Urin rutin pH 5 BJ 1,020 prot 150 blood 250 Lekosit 500 Sedimen lekosit >50 Sedimen eritrosit >10 Sedimen epitel sel 2IVP 7/10/13Fungsi sekresi dan eksresi kedua ginjal baikNephrolith dextraRadioopaque setinggi CV L2-L3. Ø 0,6cm.Foto Thorax Cardiomegaly dengan dilatation et elongation et artherosclerosis aortaeLab 29/10/13WBC: 6,2 RBC: 3,42 RBC: 10,5 HCT: 32,4 PCT: 222Lab 23/10/13Alb: 3,6Lab 22/10/13CT/BT: 8”00/3”00 PT/APTT: 13,0/28,4 GDS: 94 Ur/Cr: 31/1,0 GOT/GPT: 25/18 As Urat: 4,4 Na/K/Cl: 141/3,9/107 HbsAg & AntiHCV: Non Reaktive

9. Ny Isa14/03/194172 thn633929MRS: 01/11/13ASKESK3B3

dr. Asykar Sp U

Nefrolithiasis Sinistra

As Mefenamat 3 x 500 gr Tunggu jadwal operasi

Lab 23/10/13WBC: 7,6 RBC: 4,72 HGB: 13,1 HCT: 40,5 PLT: 257 GDS: 115 Ur/Cr: 33/1,2 GOT/GPT: 26/26 Alb: 4,1 As Urat: 6,7 Na/K/Cl: 140/4,3/105 CT/BT: 8”00/3”00 PT/APTT: 12,2/27,4Urin Rutin 23/10/13Warna: kuning PH: 6 BJ: 1,005 Prot: (-) Glk: (-) Bil: (-) Blood: 250 Sedimen leukosit: (6) Sedimen eritrosit: 7 Sedimen epitel sel: 5Foto thoraks 25/10/13Cardiomegali dengan dilatation et elongation aortaeFoto polos abdomen (BNO) 24/10/13Nefrolith bilateralUreterolith dextraFoto IVP 28/10/13Fungsi sekresi dan ekskresi ren bilateral baikHidronefrosis sinistra grade I USG Abdomen bawah 24/10/13Nefrolith sinistra

10 Ny. Ninu01/07/1961 52 thn632378MRS 10/10/2013K3B4

POD 2 cystoscopy + biopsyUlcus diabetic right foot

IVFD RL 20 tpmCeftriakson 1gr/12j/ivRanitidin 1amp/8j/ivKetorolac 1amp/8j/ivDiet DMTerapi sesuai TS BP + EM

Lab 1 4 /10/2013 WBC 6,1 RBC 3,12 HGB 8,6 HCT 26,9 PLT 575 Alb 2,2 GDS 298 Ur/Cr 12/0,4 GOT/GPT 95/54 NA/K/Cl 126/3,66/98Lab 13/10/2013WBC 6,05 RBC 3,21 HGB 8,9 HCT 25,6 PLT 458Lab 12/10/2013GDP 76 GD2PP 119 Kolesterol 68 HDL 10 LDL 46 TG 93Lab 10/10/2013 WBC 7,09 RBC 2,54 HGB 6,8 HCT 19,6 MCV

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77,2 PLT 5,6GDS 255 Ur/ Cr 9/0,8 SGOT/SGPT 108/67 Na/K/Cl 122/4,5/193 kolestero total 89 HbsAg (-) as. Urat 3,5 Urine rutin 10/10/2013warna: merah Ph 5,0 Bj 1,015 glukosa 300/++ PH 5,0 protein 150/++ Bil (-) urobilinogen (-) lekosit (500/+++) sedimen lekosit (penuh) sedimen etitrosit (penuh) sedimen torak (torak eritrosit 4-5) sedimen epitel sel (3-5)USG Abdomen atas dan bawah Kesan: Tu. Buli-buli disertai pelvpcalyectasis dextra Usul : MSCT scan abdomen dengan kateterMSCT Urografi (Stenografi) dengan Kontras 22-10-2013Penebalan dinding buli-buli ( pada bagian posterior, mukosa irregular), sesuai gambaran cystitisEmfisemaLab 22/10/13GDP: 172Lab 2/11/13WBC: 5,45 RBC: 3,71 HGB: 10,3 HCT: 29,7 PCT: 335 Foto thoraks 10/10/13Cardiomegali dengan dilatation aortae Tidak tampak tanda – tanda metastasisFoto Pelvis AP 10/10/13Tidak tampak kelainan


11 Hendrik CipangL/21/2/198132 thn 626621MRS: 17/9/2013

K10 bed 4 JKM

Hiperplasia Prostat Grade IVISKObstruksi saluran cerna ec pendesakan massa ke rectum

IVFD Amikasin 800 gr dalam 100 cc Nacl drops dalam 30 mnt/12j

Albumin / 24jSpooling kateter dengan Nacl 0,9%

Lab 29/10/13Albumin 2,7PA 24/10/2013PA 18/10/2013 Hiperplasia glandula prostatUrinalisa 21/10/2013Merah, PH 7 BJ 1,010 PROTEIN 75/++ UROBILINOGEN 4/++ NITRIT (+) BLOOD 250/+++++ LEUKOSIT 500/+++ SEDIMEN LEKOSIT PENUH, SEDIMEN ERITROSIT PENUH, EPITEL 10-15, BAKTERI (+)Lab 16/10/13WBC 8,8; RBC 3,73; HGB 11,1; HCT 33,9; PLT 187; Ur/Cr 14/0,6Lab 14/10/13Albumin 2,0Lab 10/10/2013Na/K/Cl : 132/3,5/105Lab 8/10/2013GDS 150, Ur/Cr 12,2/0,5, GOT/GPT 64/43, Prot. Total 5,9, Albumin 2,3Na/K/Cl 126/2,8/99, CT/BT 8/3, PT/APTT

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13,8(11,7)/28,6(24,8)WBC 9,8,HGB 11,8, HCT 35,6, PLT 122, RBC 3,88Lab 3/10/2013Na 125 K 2,6 Cl 94Lab 24/9/2013WBC 4,4 RBC 4,44 HGB 13,8 HCT 42,7 PLT 186 GDS 119 Ur/Cr 31/0,7 GOT/GPT 54/34 alb 3,5 na/k/cl 138/3,2/105USG Abdomen 23/09/2013Sesuai Gambaran ileus obstruktifEcho 17-9-2013Fungsi sistolik LV baik EF 79%LVH (+) mild CT Whole Abdomen (11/09/2013)Kesan : Massa Prostat.Lab 10-9-2013PSA: 4,83 Lab 6-9-2013HBsAg reactive Na/K/Cl:138/37/108 Ur/Cr 15/0,8 Lab 10/9/2013 Urine rutin : warna kuning, PH 6,5, BJ 1,015, Prot 25, sedimen leukosit > 50, sedimen eritrosit > 20, sedimen epitel sel 2, sedimen lain-lain bakteri (+), hematuria

12 Sumardi31thn631884MRS: 9/10/2013

K10 Bed 1 JKM

Tumor Buli-buli suspek malignancy CT4N2M1POH 11 Cystoscopy biopsi

IVFD Nacl 0,9% tpmAdona drips/12 jamAs tranexamat 1 amp/ 12 j/ivCefixime tab 2 x 1 mgrawat luka decubitus dengan nebo creamMiring kanan miring kiri

Hasil PA (29/10/2013)Peradangan kronik non spesifik pada buli-buliTidak ada gambaran malignitasLab 19/10/13WBC 12,67; RBC 4,24; HGB 12,8; HCT 6,3; PLT 227; PT/APTT 9,9(10,4)/24,8(25,3) INR 0,8; Albumin 2,718/10/13PSA 28,50Lab 16/10/13Alkali Fosfatase 71Urinalisis 16/10/13 Warna kuning, pH 6,5, BJ 1,015, Protein 25/+, Leukosit 100/++, Blood 150/++++, Sedian leukosit 3, eritrosis 5, epitel sel 3Lab 8/10/2013GDS 99, Ur/Cr 54/1,0, GOT/GPT 52/38, Na/K/Cl 144/3,6/105, CT/BT 6,3/3, PT/APTT 9,0(10,4)/21,2(25,4)WBC 13,39,HGB 13,9, HCT 39,7, PLT 210, RBC 4,62USG Abdomen ( 7/10/ 2013) Gambaran massa buli-buii disertai pelvocalyectasis kiri.Lab 8 - 10 -2013 HBsAg reactive Lab 10/9/2013 Urine rutin : blood 50/+++Analisa Gas darah(16/10/2013)

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pH 7,56 pCO2 43,7 SO2 96,7 PO2 16,2 HCO3 39,8 ctO2 16,5 BE 16,8 CT-scan urography (16/10/2013) Massa Buli-buli & hydronefrosis kiriFoto Thorax AP (16/10/2013) Tumor metastasis paru-paru & tulang disertai cardiomegaly danefusi minimal pleura kananFoto Lumbosacral AP/lateral (16/10/2013) Tumor metastasis ke tulangUSG abdomen (16/10/2013) Massa Buli-buli disertai pelviocalyectasis kiri

13 Jasmial11/07/1969 43 thnMRS 31/10/2013

K10.B2JKM

Hidronefrosis (S) Gr IV Delay fuction Multipel Nefrolith (S) + Kista Ginjal Kanan

As Mefenamat 3 x 1Lapor Prof hari seninRencana OP hari rabu (6/11/13)

Lab (17/09/2013)GDS 109, HBSAg (-), Anti HCV (-), RBC 4,37, Hb 13,2, HCT 39,8, PLT 224, WBC 13,7 As urat 6,0

Urinalisa warna kuning muda, ph 7 Bj 1,010 lekosit 25 sedimen lekosit 7, sedimen epitel sel 3.

echocardiografiFungsi sistolik LV baik, EF 67%. Normal resting echocardiogram

BNO-IVP (11/9/2013)Ginjal kiri fungsi ekskresi tidak tampak SP 1 jam pemeriksan

Thorax PA (20/9/2013) Pulmo normal. Elongantio aortae.Lab 31/11/13WBC: 8,4 RBC: 4,08 HGB: 12,9 HCT: 37,5 PLT: 188 GDS: 90 Ur/Cr: 21/1,2 GOT/GPT: 27/39 Al: 4,7 Ba/K/Cl: 145/4,4/108 CT/BT: 8”00/3”00 PT/APTT: 12,4/27,7 INR: 1,03

14 Muh. Tahir Lajje

12/03/1946 57thn

MRS 26/10/2013

634325JKDK10.B6

Hipertrofi prostat gr IIIHidronefrosis bilateralISKSuspek DVT

Aff InfusObat ganti oralAmoksilat 3 x 1

Lab 28/10/2013)PSA 1,15USG (26/10/2013)hipertrofi prostat, hidronefrosis bilateralLab (26/10/2013)GDS 97, ur/cr 89/1,0, SGOT/SGPT 26/24, Alb 3,1, AS. Urat 144,0, CT/BT 8’00/2’00, PT/APTT 12/28,8, Na/K/CL 37/4,3/104, WBC 16,70,RBC 3,52, Hb 10, HCT 27,8, PLT 536

Urin rutin (26/10/2013)Warna kuning, ph 6,0, bj 1,015, prot. (+3)/150, keton (+2)/15, blood (+5)/250, leokosit (+3)/500, sedimen leokosit 20, sedimen eritrosit 20, epitel sel 3

Echo 30/10/13Disfungsi diatolik LVLVH (+)EF 70%

15 Bakri 634324Tgl lahir : 04/03/1964MRS 25-10-

POH 9 cystostomiStriktur urethra pars posterior

IVFD NaCL 0.9 % 20 tpmInj. Ceftriaxone 1 gr/12j/iv

Lab (26-10-2013) GDS 101, ur/cr 30/0,8, SGOT/SGPT 23/13, alb. 3,7, as.urat 5,7, CT/BT 8’00/2’00, PT/APTT 10,0/26,4, INR 1,00Na/K/Cl 143/3,3/109, HbSAG (-) anti HCV (-)

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2013JamkesmasL2 uro K10 B3

Inj. Ranitidine 1 amp/8jam/ivKetorolac amp/8 jam/ivMobilisasi aktifRencana foto urosistografi bipolar

Wbc 15,71, Rbc 4,57, Hgb 14,1, Hct 38,6, Plt 282Foto Urethocystography striktur urethra pars posteriorThoraxpulmo dalam batas normalDilatation, elongation et atherosclerosis aortae

16 Cambede1/7/1962 51 thnMRS: 31/10/13JamkesmasK10B5

Multiple Kista Ginjal Extended

As. Traneksamat 3x1Neurodex tab 2 x 1Lapor prof

Lab 25-10-13WBC 9,9 RBC 3,77 HGB 10,4 HCT 31,8 PLT 365 BT/CT 3’00’/8’00’’ PT/APTT 14/33,3 GDS 99 ur/cr 44/2,1 SGOT/SGPT 20/23 Alb 3,5 as.urat 10,4Urinalisa warna kuning pH 6,0 BJ 1,015 protein (+) glukose (-) bilirubine (-) urobilinogen normal, sediman lekosit 6, sedimen eritrosit 4, epitel sel 2.USG Whole abdomennefrolith bilateral dengan tanda-tanda PNCFoto Thoraks AP:Cardiomegaly dgn dilatayio et elangatio aortaElevasi diafragma kanan (proses intrahepatik)Foto Polos AbdomenSpondylosis lumbalisSpina bifida occultaCT whole abdomen (tanpa kontras) 28/10/13Multiple kista ginjal bilateralEcho 29/10/13Fungsi sistolik LV baik, EF 64%LVH (+)LA dilatasiMR Mild


16 A nurbia31/12/192884 thnRM :633102MRS : 18/10/13UMUML2K11B1

Transisional Cell Carsinoma Buli2

Amoxicillin 3x500 mgRanitidin 2x150 mgCek lab lengkapRencana TUR – BT (Rabu 6//11/13)Rawat Kateter

Lab 21/10/2013GDS 111, HBA1C 4,3Lab 25/10/2013WBC 8,51, RBC 4,07, Hb 9,2, HCT 28,9, PLT 278LAB 22/10/2013GDP2PP 667 GDP 64Lab PAKesan: transitional carcinoma grade IIILab 18/10/2013CT 6’30’’ BT 2’00’’ PT 10,6(10.8) APTT 25.5(24.3) GDS 181 Ur/Cr 98/1.6SGOT/GPT 8/7Lab 7/10/2013WBC 16,5 RBC 2,86 HB 5,2 HCT 18,4 PLT CT / BT 8’00” / 3’00” {T/A{TT 10,6c10,8 /25,5 ct 24,6 GDS 181 GOT/GPT 8/7 UrineWarna kuning, pH 8, BJ 1,010 ,protein 150/+++,

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blood 250/+++, leukosit 250/+++++, sedimen leukosit >5, sedimen eritrosit penuhKesan : proteinuria, hematuriaUSG AbdomenKesan : Massa pada dinding buli-buli susp. Ca buli-buliSitologi cairan urinKesan : hapusan tidak mengandung sel epitel maligna

17 Nursia21/07/197538 thn632396MRS 10/10/2013JKML2 K11 B3

dr. M. Asykar A. Palinrungi, Sp. U.

POH 19 nefrostomi dextra Hidronefrosis bilateralCa. buli-buli

Tramadol 50mg/drips/8jRanitidin 50mg/12j/ivRawat luka/ GVTakar prod. Urin/hrDiet bebas MobilisasiTunggu jadwal APG (Rencana senin 4/11/13)

Lab 20/10/2013RBC 2.69 HB 7.1 HCT 22.3 HCT 22.3 PLT 619 WBC 15.52Lab 16/10/2013RBC 1,74 HB 4,7 HCT 14,6 PLT 467 WBC 20,8Ur/cr 72/6.5 Na 120 K 4,3 Cl 95CT 8,0 BT 2,0 PT 10,7 INR 0,9 APTT 34,7HBSAG reactiveUrinalisis hematuriaCT_Scan Abdomenkesan: gambaran massa buli-buli + hydronefrosis

bilateral ascites minimal + efusi pleura bilateralUSG Abomen (10/10/2013)Kesan : Massa buli-buli disertai hidronefrosis

bilateral+ AscitesLab (27/10/2013)WBC 12,23 HB 9,6 PLT 572 RBC 3,49 HCT 28,8Lab 30/10/13WBC: 6,6 RBC: 3,66 HGB: 9,9 HCT: 29,6 PLT: 589 GDS: 150 Ur/Cr: 38/1,3 GOT/GPT: 55/49 Pro tot: 7,6 Alb: 3,4 Na/K/Cl: 138/4,3/105

18 Mare1/7/1938RM 63140075 thn MRS 22/10/2013JKML2K11B4

POH 4 URS + DJ Stent SinistraBatu kaliks pole atas ginjal SinistraBatu ureter sinistra 1/3 distalHidronefrosis SinistraMultiple Kista ginjal sinistraMultiple kista hepar

Lanjut terapi TS DigestifMenunggu hasil BNO control ( Rencana senin 4/11/13)

Lab (04/10/2013)WBC 5,9 RBC 3,52 HGB 10,5 HCT 32,3 PLT 190 GDS 91 Ur/Cr 27/1,0 SGOT/SGPT 21/17Lab (08/10/2013)Kolesterol total 308 kolesterol HDL 49 LDL 212 trigliserida 98 asam urat 6,0urin rutin 08/10/2013kuning muda PH 5, BJ 1,010, blood 25, sedimen lekosit >50,sedimen eritrosit 7, sedimen epitel sel 12lab (09/10/2013)CT/BT 8/3 PT/APTT 11,7/32,6Urin rutin 21/10/2013Kuning muda PH 5. BJ 1,010, blood 25, sedimen lekosit 4, sedimen eritrosit 1, sedimen epitel sel 3Echo 21/10/2013-fungsi sistolik LV baik, EF 64%-Disfungsi sistolik-AR mildUSG Tiroid (08/10/2013)

10


-thyroid dalam di batas normal-penonjolan trunchus brachiocephalica kananUSG Whole abdomen (04/10/2013)-sesuai gambaran caroli disease-PNC bilateral-hidronefrosis ginjal sinistraFoto thoraks PA (11/10/2013)Pulmo normalDilatation et longation aortaeFoto BNO-IVP (11/10/2013)-non visualized urogram ren sinistra-nephrolith sinistra (UPJ)-uretrolith sinistra (UVJ) -distorsi PCS kananFoto CT Scan abdomen axial (07/10/2013)Multiple kista hepar dan ginjal kananHidronefrosis sinistra + nephrolith dan ureterolithLab 29/10/13WBC: 7,29 RBC: 3,63 HGB: 11,2 HCT: 32,0 PLT: 133 BT/CT: 3”00/9”00 PT/APTT: 11,3/32,5 INR: 0.90 GDS: 153 Ur/Cr: 26/1,20 GOT/GPT: 37/23 Na/K/Cl: 141/3,71/109 HBsAg: Non Reaktif AntiHCV: Non Reaktif.Lab 1/11/13Na/K/Cl: 140/3,8/111


19 Yamang 58 thn31/12/1954 JKMRM 629277MRS 1/10/2013K12B4

POH 13 Nefroektomi radikal ec tu. Ginjal Dextra+ Divertikelektomi Meckel reseksi anastomose ileumHipertrofi prostat gr II HipertensiGangguan mental lainnya akibat kerusakan & disfungsi otak & penyakit fisik

IVFD NaCl 0,9% 20 tpm

Viccilin sx 1g/ 8 jam/iv

Ranitidine 1 amp/8jam/iv

VIP Albumin 4x2 caps

Diet TKTPMobilisasi

dudukGV + Rawat

Luka pagi sore

LAB 28-10-13 WBC 16,17 RBC 3,52 HB 10 HCT 29,7 PLT 292 ALB 2,6 GDS 183 Ur/Cr 78/1,4 GOT/GPT 75/60 Na/K/Cl 158/4,1/129 PT/APTT 11,5/31,5 12/10 LAB PT 9,9 APTT 27,3 Na 142 K 3,4 Cl 109PSA 5,85MSCT UrografiMassa heterogen pole bawah ginjal kanan susp. Renal Cell CarcinomaHypertrhophy ProstatTRUS/TAUS : 41,9/41,8Kultur dan sensitifitas 710/2013Tidak ada pertumbuhan baktero aerobUSG Abdomen ( whole abdomen) 23/9/13Massa pole bawah ginjal kananHipertrofi pole bawah ginjal kananProstat membesar dengan vol. 47,83 mlFoto Thorax 23/9/13Cardiomegaly disertai dilatation et elongation aortaeTidak tampak tanda-tanda metastase pada foto thorax iniLAB 23/9/13

11


GDS 111, ur/cr 37/1,7 SGOT/SGPT 39/28 AS. Urat 9,1 CT 8’ BT 3’ PT 11,8 APTT 31,3 WBC 6,7 RBC 4,77 HB 12,9 HCT 40,4 PLT 333Urin Rutin 23/9/13Warna Kuning kecoklatanPH 6 blood 250 Protein 75 leukosit 3Bilirubin 1 sedimen leukosit 25 Urobilinogen 8 sedimen eritrosit 2Sedimen epitel sel 1Echocardiography 26-10-13Fungsi sistolik LV baik, EF 67%, LVH (+) ringan, disfungsi diastolicBlok Parafin 25-10-13Divertikel dengan peradangan kronik aktif, Renal cell carcinoma (differensiasi jelek)

20 Haruna 628680 1/7/1943MRS 24/10/2013JKMK12B5

Hematuri ec adenocarcinoma prostat low grade + transisional cell ca high grade

IVFD NaCL 0,9% 16 tpmInj. As. Traneksamat 1 amp /8j/ivVip albumin 4x2 capsMobilisasi jalan Rencana orchidektomi bilateralDiet TKTPRencana hormonalTerapi zseluderPeriksa lab lengkap

Lab 28/10/13Na/K/Cl 138/3,1/106 Alb 2,7 GDS 86 Ur/Cr 25/0,7 Lab 23/10/13WBC 8,1 RBC 3,45 HB 10,2 HCT 31,8 PLT 173 Na/K/Cl 134/3,7/107 CT/BT 8/3 PT/APTT 13,8/27,6USG 19/10/2013Massa prostat yang infiltrasi ke buli-buli vol.259Hydronephrosis kanan & mild hydronefrosis kiriKista Ginjal bilateralLab 10/10/2013RBC 3,38 HGB 10,3 PLT 162 WBC 9,0 Na 143 K 4,1 Cl 110Lab 8/10/13Albumin 3,8 Kolesterol total 175 HDL 53 LDL 94 TG 79Lab 3/10/2013GDS 118 ur/cr 39/1,1 GOT/GPT 46/8 alkali fosfatase 283 protein total 5,7 As. Urat 7,1Lab 28/10/13GDS 86Ur/cr 28/0,7Albumin 2,7Blok Parafin PA (16/10/13)Adenocarcinoma prostat low grade dan transisional cell Ca. High GradeMSCT 7/10/13Massa prostat dengan infiltrative ke VU dan rectum suspek malignansi + hidronefrosis dextraBNO +IVP 25/9/13Nonvisualized urogram rend extraSesuai gambaran hypertrophy prostat (suspek malignansi), suspek tumor metastasis ke tulang (tipe blastik)

21 Siru634079

Hipertrofi Prostat Gr III

Ciprofloxacin 2x500 mg

Lab 24/10/2013Na/K/Cl 137/4/109 PSA 13,99 GDS 103 ur/cr

12


1-12-1932MRS 30-10-2013JKMK12B1

Ranitidin 2x150 mg Allopurinol 100 mg 1-0-0 Tunggu hasil TRUS/TAUSTunggu hasil Kultur Urine & SensitivitasMobilisasi jalanDiet TKTP, rendah purin

44/1,5 GOT/GPT 36/37 Alb 4,3 As.urat 7,5 CT/BT 8/3 PT/APTT 13,3/27,6 WBC 5,0 HB 11,6 HCT 33,6 RBC 3,56 PLT 177Urine Rutin 24/10/2013Kuning muda, pH 5, Bj 1,025, protein 75, blood 250, leukosit 500, sedimen leukosit penuh, sedimen eritrosit >10, sedimen Kristal uric acid +2, sedimen epitel sel 3, sedimen ragi +3Foto Thorax 24/10/2013BronchiectasisCardiomegaly CTI= 0,58 disertai dilatation elongatio et atherosclerosis aortaFoto Polos Abdomen 24/10/2013Osteoporosis senilis dengan tanda-tanda spondylosis kembali lumbalis lanjutPenipisan CV L4 dengan bentuk bikonkaf (mungkin ec osteoporosis) disertai tanda-tanda degenerative diseaseFoto USG Abdomen Atas + Bawah (Whole Abdomen) 24/10/2013Hipertrofi prostat vol 66,8 cm2

Echocardiografi 25/10/2013Fungsi Sistolik LV baik, EF 64%Normal echocardiogram

22 SangkalaRM 631499MRS 21/10/13TTL 2/4/1943JKMK12B6

POH 3 sachse + vesicolitotomy ec batu bladder rect

Aff InfusPeriksa analisis batuChlorampenicol 3 x 1Asam mefenamat 3 x 1 Diet TKTPMobilisasi jalan

Lab 7/10/13WBC 8,1 RBC 4,12 Hb 12,1 PLT 430 GDS 133 Ur/Cr 32/0,8 SGOT/SGPT 24/21 As. Urat 5,1 PT/APTT 11/26,9 HBsAg (-), PSA <0,07Urin Rutin warna kuning, pH 6, keton (-), nitrit (+), blood 250, leukosit 500, protein 500BNO /IVP tgl 11/10/13Funsi sekresi dan ekskresi kedua ginjal baikVesicolith uk. 4,3x2,1 cmDivertikel buli-buliUSG (4/10/2013)Echo batu uk 2,1x0,65 cm di vesika urinaria Kesan VesicolithiasisX-RAY (4-10-2013)Kesan : Pulmonal cardiomegaly plus dilatation plus elongation et atherosclerosis aortae

23 KusnoRM 618597MRS 21/10/13TTL13/12/1954Jamkesmas

Sriktur uretra + Post cystostomi

Allopurinol 0-0-1Balance cairan Diet rendah garam, purin, kaliumMobilisasi

Lab (30/10/13)GDS 100Calsium 4,8Magnesium 2,7Na/K/Cl 153/4,8/128CT Scan Abdomen 31/10/13Athrofy ginjal kananCanul cystotomy terpasang pada buli2Kalsifikasi prostat

13


LONTARA 2 UROLOGI KAMAR ISOLASI

23 Masdin KallaL/52 thn17-9-1960MRS 22/10/13RM 633827Isolasi

Ulcus Ca testis IVFD Nacl 0,9% : dextrose 5% 28 tpmCeftriaxone 1 gr/12j/ivRanitidine 1 amp/8j/ivAllopurinol 1x300mgAlbumin inj 20% 1 vial/24jCernevit 1 vial/ 24j

Lab 29/10/2013Biakan dan resistensi (medium padat)

- Cara pemeriksaan : manual - Sampel : urine- Kultur dan sensitivity : tidak ada

pertumbuhan bakteri aerobLab 29/10/2013Na 132 K 4,5 Cl 106 CT 8 BT 3 PT 17,0 INR 1,40 APTT 30,9 AFP 1,30 Beta HCG <2,00Lab 28/10/2013WBC 10,1 RBC 2,85 HGB 8,3 HCT 24,2 PLT 309 GDS 104 ur/cr 34/0,6 prot.total 6,0 Alb 2,1 Na/K/Cl 132/3,7/105LAB 23/10/13CT/BT 8’00/3’00, GDS 37, Ureum 57, kreatinin 1,0, GDS 87, ureum 57, kreatinin 1,0, got 54, GPT 28, alb 2,3, as. Urat 8,9, Na 136, HBSAG Reavtive, HCV non reactive, WBC 14,30, RBC 2,73, HGB 8,0, HCT 23,1 MCV 84,6, PLT 429, USG Abd. Atas 23/10/13tidak tampak tanda2 metastasis pada USG abdomen ini

PALEM

24 tn. Agin63301831/12/1960 (52th)MRS: 24/10/13Askes

PA B2/13 bed 1

BPH grd IIIPOH 6 TUR-P

Levofloxacin 2x1As. mefenamat 3x1Diet biasaMobilisasi jalanAlprazolam 1 x 0,5 mg

Echocardiography 21/10/13 fungsi sistolik LV balik, EF 77%disfungsi diastolikTRAS: 71,0TAUS: 73,1Foto thorax PA(18/10/2013)Pulmo normal, cardiomegalyUSG Abdomen(11/10/2013)Prostat membesar(4,5x5,30 cm) permukaan licin Lab 17-10-13PSA: 7,19 GDS 217 Ur/Cr 29/1,2 GOT/GPT 23/14 As.urat 6,7 CT/BT 8/3 PT/APTT 1,05/3,09 Na/K/Cl 142/3,9/105 WBC 7,3 HB 14,6Urin rutin: 17/10/13warna:kuning muda, pH: 5, BJ: 1,010 leukosit 100Lab 17/10/13PSA 7,19

14


25 MusdarTL : 21/11/1952RM : 631250MRS : 14/10/2013ASKES

Palem Atas B1/9

POH 5 TUR-P Levofloxacin 2x1Tramadol 3x1Diet biasaMobilisasi aktifPA (6/11/2013)

Lab 25/10/2013Na/K/Cl 136/4,5/100Lab 28/10/2013Na/K/Cl 141/3,96/108 GDS 193Lab 21/10/13AFD 1,65 BHCG < 2,00 LDH 309 USG Testis 18/10/13Massa testis kiri susp. SeminomaLab 17/10/13GDP 239, GD2PP 326, HbA1C 6,8, Kol. Total 138, HDL 34, LDL 85, Trigliserida 98, WBC 8,2, RBC 3,95, HGB 11,4, HCT 34,3, PLT 314PSA 16/10/20133,46Lab 3 /10/2013 WBC 15,7, RBC 3,77, HGB 11,4, HCT 33,9, PLT 183, CT/BT 8’00”/3’00”, PT 12,4(10,0), APTT 34,1 (24,8), GDS 350gr/dl, Ur/Cr 37/1,8,GOT/GPT 33/54,Asam urat 6,3Lab 28/10/13WBC: 8,16 RBC: 3,48 HGB: 10,4 HCL: 29,9 PLT: 214Urin Rutin pH 5,Bj 0,10, Glukosa :1000,bilirubin : negative,urobilinogen:normal,Blood :50/250,lekosit -,sedimen lekosit 30,erittrosit 2 epitel sel 3, USG Abdomen hipertrofi prostat 83,5cmThorax Pulmo normal, Cradiomegali dengan dilatatio et elongatio aortae

26 Lintong03/03/1966624144MRS 17/10/2013

Palem BawahB2/11Bed 2askes

POH 4 URS bilateral + EKL (S) + replace DJ stent bilateral

Elektro Kinetik Limotripsi+ Batu pyelum bilateral +Batu ureter 1/3 proximal kanan

Hitung produksi urin setiap pagiCek kultur + sensitivitas urinCT Scan control (Senin, 4/11/13)Cefadroxil 2 x 500As mefenamat 3 x 500Terapi lain sesuai TS Interna

Doppler vaskuler Superior SinistraAV-Shunt berfungsi baikLab 31/10/13GDS 113 Bil.tot 4,5 Bil.direk 3,6 ALP 364 Albumin 1,9 Gamma GT 314Lab 30/10/13RBC 2,05 WBC HGB 6,1 HCT 18,6% PLT 166 Ur/Cr 52/4,7 Albumin 2,0Lab 28/10/2013Ur/cr 80/5,9 GDS 147 SGOT/SGPT 18/5 As Urat 8,0 Na/K/Cl 132/3,7/105 HBsAg nonreactiveRBC 2,16 WBC 14,0 HGB 6,4 HCT 19,5 PLT 196 CT/BT 7’00”/2’30” PT/APTT 12,4/31,3 Lab 25/10/2013GDS 199 Bil total 4,77 SGOT/SGPT 36/13 Albumin 2Malaria DDR 23/10/2013: Hasil negatif USG ABDOMEN 22/10/2013: hepatosplenomegali dengan hidronefrosis kanan PNC dengan nefrolith kiri

15


Lab 20/10/2013RBC 2,87 WBC 11,69 HGB 8,3 HCT 24,7 PLT 109 ur/cr 50/4,3 Lab 17/10/13WBC 7,8 RBC 1,76 HCT 14,5, HB 4,8 PLT 72, SGOT 27, SGPT 4, Ct/BT 8’00/3’00, PT 11,9, APTT 30,7, GDS 222, Ur 125, Kr 8,5, Albumin 2,1, Bil. Total 3,00, Bil. Direct 2,34Lab 9/10/2013WBC 8,24 RBC 8,24 HCT 26,8 APTT 22,9 GD2PP 141 ALBUMIN 2,8HB 8,7 PLT 185 BT 3,0 GDS 111 GDP 123 Na 127 Cl 7,0 K 103Lab 01/11/13IVP 23/10/2013WBC: 11,4 RBC: 2,95 HGB: 8,7 HCT: 24,8 PLT: 106 Lab 02/11/13Alb: 2,4

27 Beny Salomo28/5/1990 MRS 17/10/2013632440ASKESPalem Atas B2/10Bed 1

Vistel uretrovesica + tumor buli-buliPOH 4 Cystoscopy biopsy

Aff InfusCefadroxyl 2 x 500As mefenamat 3 x 1Tunggu hasil PA 12/11/13

Foto thorax PA (29/10/2013)Kesan : KP Duplex lama aktif dengan efusi pleura sinistraLab 29/10/2013CT/BT 9’00”/3’00” PT/APTT 13,1/26,6 INR 1,098USG scrotum 18/10/2013Kesan: Epididimitis kananCT Scan thorax 23/10/13KP duplex lama aktifFoto BNO 23/10/13Fungsi sekresi & ekskresi kedua ginjal baikTidak tampak extravasasi kontras keluar dari lumen buli-buli Fungsi ekskresi dan sekresi kedua ginjal baikTidak tampak ekstravasasi kontras keluar dari lumen buli-buliUSG abdomen 22/10/2013-hepatosplenomegay-hidronefrosis Dextra-PNC dengan nefrolitic DextraLab 11/10/13Na/K/Cl 138/3,8/102, CT/Bt 3/8, PT/APTT 11,9/27,1, Ur/Kr 12/0,8, GDS 98, GOT/GPT 18/19, Prot. Total 8,3, Albumin 4,0, As. Urat 72, WBC 8,5, RBC 4,95, HGB 12,2, HCT 36,8, PLT 370Urine rutine Warna kuning kecoklatan, pH 5, BJ 1,025, Protein 25Foto Fistulografy 11/10/13Kontras dimasukkan ke dalam salah satu muara pada scrotum, tampak kontras keluar kembali melalui muara yang lainKontras kemudian dimasukkan melalui OUE

16


sebanyak 20cc, tampak kontras masuk hingga ke uretra pars posterior. Tidak tampak kontras mengisi buli-buli (striktur uretra pars posterior)Tidak dapat dilakukan fistulografy karena kontras tidak bisa masuk kedalam buli-buliFoto thorax PA 11-10-2013: Efusi pleura sinistraBronkoskopi 01/11/13Gambaran peradangan pada bronkus lateralTidak terdapat massa intraluminal

28 Suhardin 63395117-7-60MRS: 24/10/13AskesPA B2/13 bed 2

Abses psoas kanan Hidronefrosis Dextra

Ceftriakson 1 gr/12j/ivMetronidazole 0,5gr/8j/ivRanitidin 1amp/8j/ivTramadol 1amp/8j/ivTransfusi albumin

Lab 30/10/2013Alb 1,98, LDH 1001 AFP 1,48 WBC 39,3 RBC 3,51 Hb 9,3 HCT 27,4 PLT 315MSCT whole abdomen dengan kontras (31/10/2013)- Tampak massa dengan bagian tepi/dinding tebal menyangkut post kontras, ring enhancement, batas tegas pada region sepanjang psoas kanan yang meluas ke dingding abdomen serta mendesak ginjal kanan ke cranial.- hepar, GB, lien, ginjal kanan dan sinistra, loop usus & tulang dalam batas normal.Kesan: hidropyonefrosis & psoas abses kanan, kista hepar disertai hepatomegaly.Lab 25/10/2013WBC 38,36 RBC 3,66 HB 9,8 PLT 388Lab 24/10/2013Kultur & sensitivitas = tidak ada pertumbuhan bakteri aerobGDS strip 66 GEA 1,06 WBC 35,74 RBC 2,95 HB 7,7 PLT 421Lab 23/10/13GDS 157, Ur/Cr 17/0,5 GOT/GPT 17/20, Na/K/Cl 126/4,3/99, CT/BT 8/3, PT/APTT 14,9/30,8 RBC 2,88 HB 7,6 USG abdomen 23/10/13Massa intraabdomen sisi kanan disertai pelvocalyectosis (D)

29 Nelon Lowo63251217-12-1963MRS: 24-10-13AskesPBB1/8

POH 3 URS + EKL + DJ stent sinistra

Aff InfuseGanti obat oralCefadroxil 2 x 500As Mefenamat 3 x 500Foto polos abdomen control Cek Ur/Cr control hari iniDiet rendah garam

Lab 27/10/2013Asam urat 7,2Lab 11/10/13CT/BT 7/3 PT/APTT 11,4/32,7 GDS 104 Ur/Cr 32/2,0 GOT/GPT 14/27 Na/K/Cl a42/3,85/108 WBC 18,46 HB 11,8Foto polos abdomen 21/10/13Kesan:- Nefrolith sinistra -Susp ureterolith sinistra Usul: USG abdomen IVUIVP 21/10/13Non visualized ren sinistraNeprolith et ureterolith sinistra

17


USG abdomen bawah 16/10/13Kesan: Hydronephrosis sinistra ec nephrolithUsul: BNO-IVUEchocardiography Fungsi sistolik LV baikLVH (+)Disfungsi diastolikEF 57%

30 Tn. Ishak Peokodo(60 thn)MRS : 30/10/2013AskesPA B2/8

Tu BuliKP Duplex lama aktif

Pulmo ( sudah dijawab tanggal 31/10/13 jam 09.55 dengan instruksi pemeriksaan BTA 3x)Terapi lain sesuai TS PulmoMenunggu hasil BTACek lab ulang urinalisa + kultur urin

MSCT Abd. Bawah dengan Kontras (31/10/13)Tumor buli-buli dengan infiltrasi ke rectumFoto thorax 18/10/2013

Kesan: KP duplex lama aktif, dilatatio et atherosclerosis aortaeLab 18/10/2013HBsAg nonreactive PSA 1,38 Alb 2,9 Kolesterol 175 Kolesterol HDL 33 Kolesterol LDL 114 TG 253 As urat 5,7 GDS 88 ur/cr 25/1,0 SGOT/SGPT 37/37 Na/K/Cl 136/3,6/106 WBC 9,2 RBC 4,02 HGB 11,1 HCT 34,8 PLT 283Foto polos abdomen 18/10/2013Kesan: Tidak tampak kelainan radiologic pada foto polos abdomen iniUSG Abdomen bawah (lower) 18/10/2013Kesan: massa buli-buliUrin rutin (18/10/2013)Warna: kuning muda, pH : 6,5, BJ : 1,010, protein : (-), bilirubin (-), blood 500, vit C penuh

31 Yasno WanciRM 62907105/01/1977 (36 Thn 9 Bln)MRS 30/10/13AskesB2/1 Bed 1

Nefrolithiasis BilateralBatu pole atas ginjal kananBatu pole bawah ginjal kiriHidronefrosis BilateralPost DJ Stent D/S

Pro CT Scan Abdomen tanpa kontrasPro Replace DJ Stent

Lab 30/10/13RBC 4,50 WBC 3,8 HGB 12,21 HCT 36,8 PLT 183 CT/BT 8’00”/2’00” PT/APTT 10,3/31,4 HBsAg Non-Reactive Anti-HCV Non-Reactive GDS 89 Ur/Cr 21/1,8 GOT/GPT 13/14 Na/K/Cl 142/3,7/109 Prot.Total 5,0 Albumin 4,4Foto Thorax PA/AP (30/10/2013)Tidak tampak kelainan radiologic pada foto thorax iniUSG Abdomen Atas (30/10/2013)Nefrolith bilateral disertai hidronefrosis bilateral, Slight hepatomegalyUrin Rutin 30/10/13Kuning muda, PH 6,0 BJ <1,005 Sedimen epitel sel 5, eritrosit 10, lekosit 1Foto Polos Abdomen 30/10/13Terpasang DJ Stent pada kedua lintasan tractus urinarius dengan kedua ujung proximal kiri dan kanan setinggi CV L1 dan kedua ujung distal bergelung pada rongga pelvis.

Arifin 31/12/1968632119MRS 30/10/13

Batu pole bawah ginjal kananBatu ureter proximal

Cek urinalisa kultur dan sensitivitasTunggu hasil spirometri

Lab 31/10/13WBC: 6,4 RBC: 3,77 HGB: 11,2 HCT: 33 PLT: 260 AntiHCV: - Pro tot: 7,3 Alb: 4,2 Kol tot: 236 HDL 68 LDL: 133 TGL: 173 As Urat: 8,8 CT/BT: 8/13 PT?APTT: 12,8/26,7 Na/K/Cl: 140/4,3/107

18


Askes

Dr Khoirul Khalis Sp U

kanan Terapi lain sesuai TS Interna

Darah Tepi: Leukosit dengan tanda infeksi eosinophiliaCTAbdomen Atas Bawah 9/10/13Nefrolith DUreterolith DLab 10/10/13HbA1C: 6,7 Ur/Cr: 74/2,46/7,3 GOT/GPT: 46/ 50 Kol tot: 220 LDL: 115 TGL: 529 GDS: 102 GD2PP: 120

H Muhammad 29/10/1948 (65 thn)620253MRS: 01/11/13Askes

Hipertrofi prostat grade 11Hernia inguinal dextra ReponibleStroma noduler non toxic sinistraPost NHS

Stop pemberian aspiletRencana ganti kateter urinCek status lama

Lab : belum ada

LONTARA 1

31 RosniaMRSTgl lahir 7/2/1970RM 633213AskesL1AD RPK B6

POH 2 DJ-Stent insitu bilateral

Diet dan terapi lain sesuai teman sejawat GH

Lab (31-10-2013)Ur/Cr 85/7,8 Na/K/Cl 130/4,5/96 GDP 151 SGOT/SGPT 15/13 Alb. 3,3Wbc 10,7 Hb 8,6 RBC 3,05 Hct 25,7 PLT 242Lab (28-10-2013)Ur/Cr 68/8,5 Na/K/Cl 128/4,8/96 GDS 121 Alb. 3,4Wbc 14,38 RBC 2,70 Hb 7,4 Hct 21,7 PLT 365Lab (23-10-2013)Ur/cr 133/10,7 Na/K/Cl 118/4,7/93 WBC 9,1 HB 8,9 RBC 2,16 HCT 18,0 PLT 395Lab (20-10-2013)Ur/cr 128/9,7 albumin 2,7 asam urat 6,5 Na/K/Cl 125/6,1/99USG abdomen : Hidronefrosis bilateral , simple cyst rend extra, efusi pleura bilateral, penebalan dinding VUCt – scan abdomen : Penebalan dindung buli-buli, susp. Tu. Buli-buli, hidroureter & hidronefrosis bilateral, ascites, efusi pleura bilateral

32 Kamaruddin620080Tgl lahir 30-12-1967MRS 19-10-2013JamkesmasL1BBK7B 4

DJ-stent insitu bilateral

Rencana evaluasi DJ-stent bilateralAlih rawat urologi

Lab (25-10-2013) :Wbc 8,0 RBC 3,01 HGB 8,5 HCT 26,6 PLT 289GDS 141, ur/cr 71/4,0 Na/K/CL 134/3,4/102USG abdomen (22-10-2013) :Nefrolith sinistra

33 SukiraRM 632831Ttl : 1-4-

- Nefrolith bilateral- uretholitiasis

Tunggu hasil kultur urineBoleh pindah

Lab 31/10/13-biakan dan resistensi (medium padat)Cara pemakaian manual

19


1964MRS 27-10-2013L1BBk4b1

sinistra- hidronefrosis + hidroureter sinistra

perawatan uro Kultur dan sensitivitas tdk ada ptumbuhan bakteri anaerobLab (21-10-2013)

CEA 1,55Na/K/Cl 141/4,1/111 Ct/Bt 2’00/7’00 PT/APTT 13,1/25,7

Lab (17-10-2013)INR 0,80 GDS 101 Ur/Cr 37/0,9 SGOT/SGPT 14/20Bil. Tot 0,47 Bil. Direct 0,13 Prot. Tot 6,4 Alb. 3,3Wbc 10,04 Hb 12,3 Rbc 4,41 Hct 36,2 Plt 208BNO-IVP (23-10-2013) :- hidronefrosis grade IV et hydroureter ren sinistra- nefrolith dextra (pole atas )- Uretrolith sinistraCT-Scan Abdomen atas bawah tanpa kontras (22-10-2013) :- Nefrolith bilateral - Hidronefrosis dan hidroureter sinistra ec. UretrolithXRay Thorax (21-10-2013):- Bronchopnemoni dextra- elongatio aortae

34 IskandarMRS 25/10/2013L1ABK4B4TTL : 11-1-1972RM 619535nd

Tunggu hasil ur/crFoto thorax PATunggu hasil konsul TS. GH

Ceftriaxon 1gr/12j/ivPCT 3x1Ranitidin 1gr/8j/iv

Usg abdomen (28-10-2013)terpasang dj-stent bilateralnefrolith sinistraLab : (27-10-2013)as. Urat 4,3 Na/K/Cl 142/4.1/107Lab : (23/10/2013)Urine rutin : warna kuning keruh, pH 7,0, Bj 1.105, prot +++/150, glukose negative, bilirubine negative, urobilinogen negative, keton negative, nitrit positive, blood +++++/250, lekosit +++/500, sedimen lekosit penuh, sedimen penuh, sedimen epitel sel 7.Lab darah rutin :Ct/bt 8’00”/3’00”, pt/aaptt 11,2/27,2, INR 0,90, gds 104, ur/cr 64/4,3, sgot/sgpt 19/14, alb 3,9HbSAG (-), anti HCV (-)Wbc 9,09, rbc 3,37, hgb 9,9, hct 29,0, olt 296

LONTARA 2 DIGESTIVE

35 By. SakirahTTL 24/112012MRS 26/9/2013RM 580305L2 AD K12 B6

Ektropi Buli-buli+ colostomy+ISPA

Konsul perioperatifDietTS sesuai bedah anak

Lab 24/10/2013WBC 23,21 RBC 5,21 HGB 11,3 HCT 35,2 PLT 382 PT/APTT 10,2/24,9 INR 1,0Tes Sensitivitas Antibiotik Ciprofloxacin & MeropenemLab 19/10/2013WBC 23,21, RBC 5,21, HGB 11,3, HCT 35,2, MCV 67,6, MCH 21,7, MCHC 32,1, PLT 382, PCT

20


0,37, PT 13,8 control 10,2, INR 1,0, APTT 34,0 control 24,9Lab 10/10/2013CT 7’3”, BT 3’00, Alb 5,0, WBC 17,7, RBC 6,29, HCT 41,2, PLT 589

LONTARA 2 ORTOPEDI

36 Dzawil ikramTTL 11/9/2001MRS 5/10/2013RM 631536K5B3Lontara 2 bawah orto

Hematom scrotal ec. Laserasi dinding porsiiorchitis kanan Fraktur pelvis + fraktur femur

- Diet dan terapi lain sesuai TS ortopedi

- Boleh rawat jalan

- Konsul poliklinik

Lab 21/10/2013WBC 11,32 RBC 4,40 HGB 13 HCT 35,3 PLT 419Lab 17/10/2013Elektrolit : Natrium 136, Kalium 4,6, Klorida 102, GDS 81, Ureum 34, Kreatinin 0,3, SGOT 24, SGPT 13Waktu bekuan 8’00”, waktu perdarahan 3’00”, PT 12,0 control 11,3, INR 1’00, APTT 24,6 control 25,2WBC 9,2, RBC 4,02, HGB 11,2, HCT 33,0 MCV 82, MCH 27,9, MCHC 34,0, PLT 708, MPV 8,3, PCT 0,589Kultur UrineTidak pertumbuhan bakteri aerobLab 7/10/2013RBC 3,60, HGB 10,3, HCT 31,2, PLT 16,3, WBC 6,3USG Abdomen 5/10/2013Buli-buli dalam batas normalCairan bebas minimal intraperitoneumLaserasi dinding posterior testis kananUrinalisa 510/2013Protein 150/+++, blood 250/+++++, leukosit 500/+++Lab 5/10/2013GOT/GPT 234/130, Na/K/Cl 134/4,5/105, HbsAg(-), Anti HCV (-)CT/BT 7’00’’/2’30’’, PT/APTT 11,2(10,0)/28(25,8), INR 0,90, GDS 87, Ur/Cr 95/3,0.

LONTARA 3

38 I Gusti PutuTLL 23/09/2011RM 63261013/10/2013L3Kul-kel AD K2B3

Tumor retrovessica susp. infiltrasi ke buli-buli

Penjadwalan operasi dari bedah anak (Joint op)Rencana cystoscopy

URIN RUTIN 19/10/13Wrn kuning tua, PH 6.0, BJ 1,015, sedimen leukosit 1, eritrosit 1, epitel sel 1.LAB 13/09/2013RBC 5.58, WBC 8.5, HGB 11.5, HCT 36.5, PLT 402, SGOT 35, SGPT 17, na 147, k 5.17, cl 112, HBsAg non reactif, anti HCV non reactif, CT 7’30,BT 3,00, PT 78/10.4, INR 0.80, APTT 24.1/24.8, GDS 92, Ur 91, Kr 0.4

Rumaeda1/8/1962 (51thn)

Nefrolitiasis dextra ISK

Ranitidin 2 x 150As mefenamat 3

Lab (28/10/13)WBC 6,2, RBC 4,71, HB 13,0, HCT 38,3, PLT 321Na/K/Cl 141/5,2/103 HBsAg non reactive

21


634487MRS 31/10/13JKML3K2B4

dr Syakri syahrir Sp U

x 500Cek kultur dan sensitivitasKonsul perioperatif

BT 7’00’ CT 3’00’ PT/APTT 12,9/26,7 GDS 112Ur/cr 26/0,7 GOT/GPT 29/20 albumin 5,0 Asam urat 4,4Urin rutin (28/10/13)Blood 250Leukosit 100Sedimen leukosit 8 sedimen eritrosit >30USG (28/10/13)Nefrolith dextraEcho (29/10/13)fungsi sitolik LV baik, EF 65 %, disfungsi diastolicFoto Thoraks (28/10/13)pulmo normal, atheroskelerosis aortaeIVP(31/10/13)fungsi sekresi dan ekskresi kedua ginjal baik

LONTARA 4

39 Jenne1/7/1958622762MRS 15/8/2013JKML4 K1 B4

D/POH 10 nephrostomy Fistel vesicovaginalisFistel uretero rectalisFistel vesicocutaneus

As mefenamat 3x500Cefixime 2x100Neurodex 2x1Takar prod. Nefrostomi dan kateter urinRanitidin 2 x 1 tabPCT 3 x 500 mg

LAB 18/10/2013WBC 9.3, RBC 3.49, HGB 10.4, HCT 31.4, PLT 379, Na 126, K 33, Cl 92Lab 31/10/13WBC 16,8, RBC 3,75, HB 11,6, HCT 34, PLT 469Echocardiography (17/10/2013)fungsi sistolik LV baik ,EF 60% ,MR mild, disfungsi diastolic.LAB 7/10/13 HbsAg (-) HCV (-) Albumin 3,0-4,2 Urine : Warna : kuning keruh PH 8 BJ 1,010 prot 25 blood 150 lekosit 25 Lab 25/9/2013 GDS 97 Ur 13 Cr 0,8 GOT 24 GPT 10 Alb 2,7 Lab 18/9/2013CT 8 BT 3 GDS 88 Ur 18 Cr 1,0 GOT 15 GPT 5 MSCT abdomenFistel rectoureteral kiriFistel vesicovaginalis dan ekstravasasi kontras ke ekstraperitonealHidronefrosis ec stenosis distal ureter kiriFoto Thorax PA 17/10/13

- Pulmo normal- Aterosclerosis aorta.

40 Ny. Ramlah28/9/1969Rm 630463Mrs: 29/9/2013Konsul 22/10/2013L4k2b3

Hidronefrosis (D) ec. Susp pembesaran massa tumor ke muara uretra Ca Cerviks

POH 3URS (D) + pasang DJ Stent

Lab (31/10/2013)WBC 15,21 RBC 3,87 HB 9,6 HCT 28,7 PLT 530 GDS 127 Ur/Cr 71/1,3 GOT/GPT 17/20 Albumin 3,6 HBsAg Non-reactiveMSCT Whole abdomen (16/10/2013)

- Ca cervix dengan hematometra dan hidronefrosis (D) (sesuai FIGO IIIB)

Lab (9/10/2013)- Ureum 23 kreatinin 1,1

USG abdomen (7/10/2013)- Kesan hidronefrosis dextra

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Foto thorax (4/10/2013)- Pulmo normal- Cardiomegaly dengan dilatasi aorta

Lab (1/11/2013)WBC 11,9 HCT 23,5RBC 4,9 PLT 569HGB 9,6Lab 29/10/2013GDS 127 CT/BT 8/3 Ur/Cr 71/1,3 Albumin 3,6 HBsAg(-) WBC 11,00 RBC 2,99 HGB 6,1 PLT 864Lab 1/11/13WBC 10,2, RBC3,63, HB 9,1Na/K/Cl 135/5,2/101Ur/cr 43/1,2Albumin 3,7BNO 1/11/13DJ Stent terpasang pada tractus urinarius (S), kedua psoas line intakeTidak tampak bayangan batu radiopak pada kedua lintasan traktus urinarius, kedua preperitoneal fatline intakTulang2 intak, osteofit pada CV-L3 sampai lumbal 5 (spondilosis lumbalis)

41 Irruse43 thn Mrs: 23/10/2013633985L4K2B5

Hidronefrosis D ec susp pembesaran massa tumor ke muara uretra

Rencana URS +DJ stent DBesok tanggal 4/11/13Cek PT, APTT, INR

USG Abdomen(2 negative 5/10/2013) Kesan: massa segmen bawah rahim dengan infiltrasi uterus dan hydronefrosis (D)

Massa kistik adneksa bilateral Foto thorax PA/AP(25/10/2013)Kesan: tidak tampak tanda0tanda metastasis pada foto thorax iniMSCT Whole abdomen dengan kontras(25/10/2013)Kesan:

Ca cervix Massa adneksa bilateral Efusi pleura minimal dan bilateral

Lab(23/10/2013)CT/BT 8/3 GDS 104 Ur/Cr 46/0,6 albumin 3,6 ABsAg(-) WBC 11,72 RBC 4,39 HGB 9,9 HCT 30 PLT 430Lab 1/11/2013Na/K/Cl 133/4,4/98Ur/cr 32/1,3Albumin 3,6WBC 6,1, RBC3,85, HB 9,0, HCT 25,3, PLT 345

42 Eme Ransiana53 tahun25/05/1960L4K2B4

Massa adneksa Hidronefrosis bilateralHidroureter bilateralBatu PUJ (D)

IVD NaCl 0,9% 20 tpmCeftriaxone 1 gr/12j/ivTransfusi PRC 2 unit

Lab (31/10/2013)WBC 17 RBC 3,64 HB 10,3 PLT 589Lab(28/10/2013)CT/BT 8/3 GDS 143 Ur/Cr 72/2,3 HBsAg(-) WBC 19,8 RBC 2,92 HGB 8,3 HCT 25,7 PLT 564USG Abdomen Atas + Bawah (Whole Abdomen

23


Susp. TB paru EKG + EchoPeriksa BTA

(16/10/2013)Kesan :-Massa Adneksa dengan tanda-tanda torsi-Hidronefrosis bilateralMSCT Whole Abdomen (18/10/2013)Kesan :-Massa adneksa-Hidronephrosis grade IV e.c batu PUJ kanan-Hidroureter kananFoto Thorax PA/AP (16/10/2013)Kesan :-Platelike atelectasis kiri-Cardiomgaly dengan dilatation et elongatio aortae-Tidak tampak metastasis pada foto thorax iniCT Thoraks (tanpa kontras) (23/10/2013)Kesan : KP dextra lama aktif

INFECTION CENTER

43 Ayub Danari25/071938MRS 21/9/2013RM 629136IC Lt.2 ICU k2b2

BPH grade II + TB Paru

Urin rutin dan kultur sensitivitasTRUS/TAUS bila KU baikTerazosin 2mg 0-0-1Alopurinol tab 100mg

Lab 25/10/2013As urat 6,0Foto thorax 17/10/2013Kp dupleks lama aktif, efusi pleura D, dilatasi aortaPA(10/10/2013) Evaluasi sitologi cairan pleura, lesi hemoragik tidak mengandung epitel malignantPA(30/9/2013) evaluasi sitologi cairan pleura, AV shunt tidak terdapat sel epitel malihnantLAB 17/10/2013Albumin 2,9 Lab 15/10/2013Albumin 2,6Lab 11/10/13 Ur/cr 14/0,7 prot tot 4,3 albumin 2,1 HbSAg (-) Anti HCV (-) GDS 153 RBC 4,49 hb 9,9 HCT 29,8 PLT 240 Urin rutin : warna kuning jernih BJ 1,010 prot 25/+ leukosit 150/++ sed. Leukosit 4-8 sed. Eritrosit 0-2 sed. Eppitel sel 1-3. Lab 5/10/2013Ur/Cr 49/1,0, WBC 8,71, RBC 3,77, HGB 10,9, HCT 32,0, PLT 277Lab 7/10/2013HBA1C 4,6, Albumin 2,2Foto thorax 24/9/2013- Efusi pleura massif dextra- Tidak tampak densitas massa pada kedua paru

USG Abdomen- Efusi pleura dextra- Hipertrofi prostat (uk: 3,9x4,7x4,3x4x2 )

ICU

24


44 Opiy L. Kafili20/9/1946MRS16/10/13RM 463284ICU vip utama

D/ Ca ProstatCKD on HD

Terapi sesuai TS GH

LAB 31/10/13 WBC= 4,9. RBC= 2,98. Hb=8,4. HCT= 24,8. PLT=30Na/K/Cl= 144/3,4/110GDS= 119. Ur=63. Cr= 0,8. ADT Anemia normositik normokrom s/ kausa peny.kronik dgn tanda hemolitik uremik disertai tanda infeksi ringanLAB 24/10/13Ur/Cr 10,0/2,0 DDimer 2,1 Na/K/Cl 12/2,5/10 CT/BT 8/3 PT/APTT 12,7/26,5 INR 1,23 ICRP 339 WBC 3,6 RBC 2,49 HGB 6,8 HCT 20,4 PLT 63LAB 22/10/13 PT 14,6, INR 1,19, APTT 33,9, GDS 166, Ureum 249, Kreatinin 4,1, GOT 162, GPT 74, Alb 3,1, Na/kal/klo 149/2,7/114, WBC 9,69 RBC 1,78 HCT 15,0 PLT 54 PCT 0,06

PICU

CVCU

RSUH

45 Tn. LambertusMRS : 25/10/2013RM : 012682412

- Retensi urine ec. Susp. Kontraktur

- Bladder neck- CHF NYHA

III

- Pasang kateter- Pasang simino- Hammal 0,4 mg 0-0-1- Balance cairan- Terapi lain sesuai Ts

Interna

Lab 27/10/13Ur/Cr 287/10,4Lab 30/10/13Ur/Cr 158/4,3 Na/K/Cl 136/4,3/96 WBC 4,55 RBC 3,69HGB 10,2Echo 30/10/2013VH dengan hipertropi septal, TR mild-moderate PH mild

46 YunusL/ 12-07-1968MRS 16/10/2013RM014659Lantai 4/ K 414

Post op Pyelolitotomi hr 17 e.c Multiple batu ren (D)

- IVFD NaCl 0,9% 16 tpm

- Meropenem 1g/12j/IV amp/ 8j/ iv

- Ranitidine amp/8j/iv- Ketorolac 1amp/12j/iv- Diet tinggi protein- GV pagi siang- Mobilisasi duduk/jalan- Aff hecting selang

seling

BNO :kontur ginjal sulit dievaluasi, posisi ujung cranial DJ stent lebih tinggi dari posisi neprolith (mungkin ujung DJ Stent berada di luar PCS)Lab 25/10/2013WBC 10,17 RBC 3,38 HB 9,8 PLT 184 Na/K/Cl 134/3,9/101 Ur/Kr 102,5/1,9Lab 24/10/2013WBC 7,08 RBC 2,98 HB 8,7 PLT 165Lab 23/10/2013WBC 8,29 RBC 2,74 HB 7,9 PLT 166Lab 22/10/2013WBC 8,44 RBC 2,69 HB 8,5 PLT 189 Ur/Kr 82/2,4 Na/K/Cl 130/4,4/98 alb 3,0 GDS 145Urin: Protein 25/+; blood 25/++; lekosit 100/++ BNO:

25


- drain tube terpasang pada regio hipochondrium kanan dengan ujung setinggi CV L2- tampak DJ-stent dengan ujung

proximal dan ujung distal berada didalam rongga pelvis

- Tampak bayangan batu bulat multiple pada region hipochondrium kanan (nephrolith)

- Tulang-tulang intak, tampak spur formation pada aspek lateral CV L1-5 ( spondylosis lumbalis)

Analisa batu: warna abu-abu kehitaman, 1 batu berukuran 2x2x1cm, 2 batu berukuran 1x1x0,5cm, 2 batu berukuran 0,5x0,5x0,2cm, 3 batu berukuran 0,2x0,2x0,2cm, permukaan halus, bentuk bulat tidak beraturan. Calcium 40, oksalat 50, phosphate 2,5.kalsium 17%,fosfat 2,5%Kesan : batu memiliki ikatan kalsium-oksalat 84%, sisa unsur Lab 17/10/2013WBC 15,24 RBC 4,06 HGB 12,7 PLT 194Lab 8/10/2013Na/K/cl 134/3,8/104 prot total 7,2 alb 4,1 GDS 106 as.urat 7,9 Ur/Kr 60,7/1,8Foto thorax: cardiomegaly disertai dilatation et elongation aortaeCT-Scan Abd 4/10/2013- Nefroliths dextra disertai

hidronefrosis dextra- Simple renal cyst sinistra

USG Abd 3/10/2013- Nefrolith kanan- Kista ginjal kiri

Hipertrofi prostat (ringan)Lab 25/10/13WBC: 10,7 RBC: 3,38 HB: 9,8 HCT: 29,1 PLT: 184 Na/K/Cl: 134/3,9/101 Ur/Cr: 102,5/1,9

47 YACUB RASYID 14/08/1959MRS : 26/10/13ASKES

Post Bivolve ginjal D H VI

- IVFD NaCl 0,9% 28 tpm

- Takar produksi urin/24j- Boleh diet- Mobilisasi duduk- Obat oral lanjut

Foto BNO 24/10/2013Materiorisme dengan impacted fecal massLab 28/10/2013WBC 16,9 RBC 4,71 HGB 12,3 Na/K/Cl 135/4,2/105 ur/cr 28/1,4 PLT:

26


Kamar 419 - Cefadroxyl 2 x 1- As Mefenamat 3 x 1- Ranitidin 3 x 1

169 Na/K/Cl: 135/4,2/104 Utr/Cr: 28/1,4 PT/ PTT: 14,4/1,19

48 Ny.A.Markis11/08/1953013234MRS:30/10/2013ASKESKamar 407

Post Nefroctomi Hari 3 e.c Batu staghorn (s)

- VFD NaCl 0,9% 28 tpm- Ceftriaxon 1 g/12J/iv- Ranitidin amp/8j/iv- Vip Alb 3 x 2 - Mobilisasi duduk- Diet biasa- Besok aff infus ganti obat

oral

Lab 28/102013Asam urat 3,9Foto BNO/IVP 24/10/2013- Batu staghorn et non visualized ginjal kiri- Fungsi eksresi dan sekresi ginjal kanan baikFoto polos abdomen AP 21/10/2013- Batu staghorn ginjal (s)Lab 18/10/2013WBC 8,78 RBC 4,81 HGB 13,9 Plt 311 HbsAg (-) Anti HCV (-) Na 133 K 4,4 Cl 102 SGOT 15 SGPT 11 GDS 100 Ureum 31 Kreatinin 0,9sLab Urin 18/10/2013Blood Positif 2(50 rbc/ul)ssUSG Abdomen 17/10/2013- Severe Hidronefrosis (s)- Simple renal cyst (d)

49 SyaharuddinL/31/12/1937MRS:01/11/2013RM 015424Lantai 4K426

BPH gr III + HN BilateralCronic Liver diseases

- IVFD NaCl 0,9% 20 tpm- Ceftriakson 1gr/12j/iv-Ketorolac 1amp/8j/iv-Ranitidin 1amp/8j/iv-CT Abd dan CT urografi

bila urin cukup , 600 cc/12j

-Lengkapi pemeriksaan lab-Kultur urine + PSA

Lab 01/11/2013PT 16.5 APTT 40.9Na 141 Cl 102 K 4.1SGOT 67 SGPT 49 GDS 220 Plt 70Ureum 37.6Kreatinin 0,9Lab urin rutin 01/11/2013Blood positif 3 (250 rbc/ul)USG Abdomen 01/11/2013- Hydronephrosis bilateral dengan

hypertrophy prostatascites minimalLab 2/11/13HbsAg (-) AntiHCV (+) PT/APTT: 16,5/40,9 GDP: 137 HbA1C: 5,8 Gamma GT: 74,7 Bil tot: 3,4 Bil direc: 1,2 Pro tot: 6,4 Alb: 2,8 AFP: 7,88Lab 3/11/13GDS: 135 Kol tot: 128 LDL: 73 HDL: 53 TG: 71 As Urat: 5,4

PCC

50 Lina kogoyaP/ 5-12-1968MRS 22/10/2013RM 633809Lantai 2 k213

POH 2 URS + DJ stent

Instruksi post op- Ceftriaxon 1

gr/12j/iv- Ketorolac

amp/8j/iv- Ranitidin

amp/8j/iv- Foto BNO

Lab 29/10/2013Ur 14 cr 0,8 Na/K/Cl 136/3,8/105Lab 28/10/2013WBC 4,15 RBC 4,04 HCT 32,7 HB 11 PLT 168 ur/cr 16/0,8 GDS 362Lab urin 25/10/2013Protein (-) glukosa 1000/++++Lab 25/10/2013WBC 4,5 RBC 3,16 HB 8,6 PLT 175

27


dibuat kemarin tgl 31/10/2013

- Hasil biopsy tgl 8/11/2013

- Mobilisasi duduk

Lab 23/10/2013CT/BT 7/3 PT/APTT 12,8/27,8 GDS 179 Ur/Kr 12/0,9 GOT/GPT 25/8 Na/K/Cl 143/4,3/108CT abd dgn kontras 23/10/2013- Hidronefrosis (D) dengan tanda-tanda delay

function- Hepatosplenomegaly

Lab 22/10/2013CT/BT 7/3 PT/APTT 12,8/27,8 GDS 179 UR/KR 12/0,9 GOT/GPT 25/8 Na/K/Cl 143/4,3/108USG 22/10/2013- Hepatosplenomegaly- Nefrolith dan hidronefrosis (D)

Urin: protein 25/+, blood 25/++, lekosit 100/++

UGD

Laballa 01/07/194073 thn635460MRS: 02/11/13Umum

Retensi urine c batu uretra posterior

-CT scan Abd tanpa kontras

-Besok cek ureum kreatinin

Lab 2/11/13WBC: 11,55 RBC: 3,81 HGB: 11,5 HCT: 31,4 PLT: 234 GDS: 78 Ur/Cr: 97/9,6 GOT/GPT: 26/20 Pro tot: 3,6 Alb: 3,4 Na/K/Cl: 133/3,7/104 HbSAg Anti HCV: Non reactiveFoto polos Abd 2/11/13Tidak tampak bayangan batu radiopak pada foto polos abdomen iniUSG Abd Atas Bawah 2/11/13Hidronefrosis bilateral ec nefrolitiasis bilateralSuspek uterolith dextraCystitis dengan vesicolithiasis

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