Tuberkulosis Resus

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    REFLEKSI KASUS

     TUBERKULOSIS

    REZKY MAWARNI

    20100310187

    PEMBIMBING : dr. D! A"#$r$%!& S'. A

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    N$"$ : A(. A

    U")r : 3 %*  +,(!- K,$"!( : $/! $/!

    A$"$% : T$"$( M)%!$r$

    M$-)/ RS : 20 D,-,"#,r 201

    IDENTITAS PASIEN

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    Keluhan Utama :

    P$($- 2 "!()& #$%)/ 3 "!()

    Riwayat Penyakit Sekarang :

    P$-!,( d$%$( d,($( /,)*$( '$($- -,4$/

    2 "!() d$( #$%)/ 3 "!() 5$( $).

    P$($- *!$( %!"#) 6& P)-!( 6& ",(!!69& (5,r! ',r)% 69& ")$ 6& ")(%$* 6 2 &

    ($;-) "$/$( ",()r)( 6& BAB

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    Riwayat Penyakit Dahulu

    B,)" ',r($* ",($$"! *$ 5$( -,r)'$ Riwayat Penyakit Keluarga

      K$/,/ #$%)/ $"$ 6TB Riwayat Tumbuh Kembang

     T!d$/ $d$ /,%,r$"#$%$( %)"#)*/,"#$( Riwayat Imunisasi

    L,(/$'

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    K,$d$$( U")": >M& ,"$-

    K,-$d$r$( : >M

    B,r$% B$d$( : 1? /

     T!(! B$d$( : 10 @"

    R : 100

    S%$%)- !! : #$!/

    PEMERIKSAAN FISIK 

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    KEPALA

    B,(%)/ /,'$$:

    N=r"=@*,'$ M$%$: >,/)( 69

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    ADO!E"

    I(-',/-! : -!",%r!- P$'$-! : S)',&

    %)r=r #$!/& *,'$r d$(

    !,( %!d$/ %,r$#$

    P,r/)-! : T!"'$(!&

    #$%$- *,'$r (=r"$.

    A)-/)%$-!: B!-!( )-)-

    6 (=r"$

    EKSTRE!ITAS

    $/r$ *$($% 6&-!$(=-!- 69& >RT 2

    d,%!/.

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    PEMERIKSAAN

    PENUN+ANG ',",r!/-$$( $#=r$%=r!)"

    PE!ERIKSAA" HASIL "ILAI RU#UKA"

    HE!ATOLO$I

    L,/=-!% ?&7 &911

    ,"==#!( 12&3 1918

    ,"$%=/r!% 3& 329

     Tr="#=-!% 2 1090

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    R$d!==!

    P,",r!/-$$( ;*=%= %*=r$

    RLD >=r : >RT

    P)"= :

    >=r$/$( #r=(/=C$-/)$r/$-$r *5)- "$-!* $$/

    %,#$ T$"'$/ #,r@$/ /,-)r$"$(

    *$)- d! ')"= DOR : DBN

    P)"= : Pr=-,- -',-!H/

    M$(%=) %,-

    P=-!%!; 6 10 ""

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    D!$(=-!- K,r4$ :

    9 PKTB

    DIAGNOSIS

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    P$r$@,%$"= 3 1 @%*

    R!;$"'!-!( 1?0 " 11 *$r!

    I-=(!$!d 1?0 " B? 10 " 11 *$r!

    P!r$!($"!d 1?0 " 11 *$r!

    PENATALAKSANAAN

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    1. B$$!"$($ @$r$ ",(,$//$( d!$(=-!-

    '$d$ %)#,r/)=-!- '$d$ $($/ J

    2. B$$!"$($ ',($%$$/-$($$( '$d$ '$-!,(%)#,r/)=-!- '$d$ $($/J

    3. M,($'$ =#$% !-=(!$!d d!#,r!/$( #,r-$"$d,($( B?J

    MASALA YANG DIKA+I

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     T)#,r/)=-!- $d$$* ',(5$/!% !(;,/-! 5$(

    d!-,#$#/$( =,* "5@=#$@%,r!)" %)#,r/)=-!-.

    M5@=#$@%,r!)" %)#,r@)=-!- $d$$* #$/%,r!#,r#,(%)/ #$%$( $,r=# 5$( %!d$/ ","#,(%)/-'=r$. P$d$ 4$r!($(& #$-! %)#,r/)=-!- $d$$*#$/%,r! #$%$( %!'!- )r)- #,r)/)r$( -,/!%$r 0&3 ". M!/=#$/%,r!)" %!d$/ d$'$% d!/$-!;!/$-!/$(",(4$d! r$"9'=-!%!; $%$) r$"9(,$%!;. B$-!%)#,r/)=-!- d!%$(d$! d,($( %$*$( $-$".

    ANALISA MASALA

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    P$r) ",r)'$/$( '=r% d,(%r, ,#!* d$r! 8 /$-)- !(;,/-!

     TB. K$r,($ )/)r$((5$ 5$( -$($% /,@!& /)"$( TB d$$"',r@!/ r,(!/ 6dr=',% ()@,! 5$( %,r*!r)'& d$'$% ",(@$'$!

    $C,=)-. M$-)/(5$ /)"$( TB !(! $/$( -,,r$ d!$%$-! =,*",/$(!-", !")(==!- (=( -',-!H/. M$/r=;$ $C,=)-$/$( ",(;$=-!% /)"$( TB d$( #!$-$(5$ -$()'",(*$(@)r/$( -,#$!$( #,-$r /)"$( TB. A/$( %,%$'!&'$d$ -,#$!$( /,@! /$-)-& "$/r=;$ %!d$/ "$"')

    ",(*$(@)r/$( /)"$( TB d$( /)"$( $/$( #,r,'!/$-!d$$" "$/r=;$. K)"$( TB d$$" "$/r=;$ 5$( %,r)-#,r/,"#$( #!$/& $/*!r(5$ $/$( ","#,(%)/ /==(! d!%,"'$% %,r-,#)%. L=/$-! ',r%$"$ /==(! /)"$( TB d! 4$r!($( '$r) d!-,#)% %&kus Primer $OH"'

    P$%=,(,-!-

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    D$r! ;=@)- 'r!",r& /)"$( TB ",(5,#$r ",$)!-$)r$( !";, ",()4) /,,(4$r !";, R,!=($.P,(5,#$r$( !(! ",(5,#$#/$( %,r4$d!(5$ !(Q$"$-!

    d! -$)r$( !";, 6!";$(!%!- d$( d! /,,(4$r !";,6!";$d,(!%!- 5$( %,r/,($. +!/$ ;=@)- 'r!",r%,r,%$/ d! =#)- '$r) #$$* $%$) %,($*& /,,(4$r!";, 5$( $/$( %,r!#$% $d$$* /,,(4$r !";,

    '$r$*!)-& -,d$(/$( 4!/$ ;=@)- 'r!",r %,r,%$/ d!$',/- '$r)& 5$( $/$( %,r!#$% $d$$* /,,(4$r'$r$%r$/,$. K&m(leks (rimer ",r)'$/$($#)($( $(%$r$ ;=@)- 'r!",r& /,,(4$r !";,r,!=($ 5$( ","#,-$r 6!";$d,(!%!- d$( -$)r$(

    !";, 5$( ",r$d$( 6!";$(!%!-.

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    W$/%) 5$( d!',r)/$( -,4$/ "$-)/(5$

    /)"$( TB *!($ %,r#,(%)/(5$ /="',/-

    'r!",r -,@$r$ ,(/$' d!-,#)% -,#$$! masainkubasi T. M$-$ !(/)#$-! TB #!$-$(5$#,r$(-)( d$$" $/%) 98 "!() d,($(r,(%$( $/%) $(%$r$ 2912 "!(). D$$"

    "$-$ !(/)#$-! %,r-,#)%& /)"$( %)"#)**!($ ",(@$'$! 4)"$* 1039101& 5$!%) 4)"$*5$( @)/)' )(%)/ ",r$(-$( r,-'=(-!")(!%$- -,),r.

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     P$d$ -$$% %,r#,(%)/(5$ /="',/- 'r!",r !(!$*&

    !(;,/-! T (rimer d!(5$%$/$( %,$* %,r4$d!. $%,r-,#)% d!%$(d$! =,* %,r#,(%)/(5$

    *!',r-,(-!%!C!%$- %,r*$d$' %)#,r/)='r=%,!(& 5$!%)%!"#)(5$ r,-'=(- '=-!%!; %,r*$d$' )4! %)#,r@)!(.S,$"$ "$-$ !(/)#$-!& )4! %)#,r@)!( "$-!*(,$%!;. S,%,$* /="',/- 'r!",r %,r#,(%)/&

    !")(!%$- -,),r %)#)* %,r*$d$' TB %,$*%,r#,(%)/.

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    S,%,$* !")(!%$- -,),r %,r#,(%)/& ;=@)-

    'r!",r d! 4$r!($( '$r) #!$-$(5$ ",($$"!

    r,-=)-! -,@$r$ -,"')r($ ","#,(%)/ H#r=-!-$%$) /$-!H/$-! -,%,$* ",($$"! (,/r=-!-',r/!4)$( d$( ,(/$'-)$-!. K,,(4$r !";,r,!=($ 4)$ $/$( ",($$"! H#r=-!- d$(,(/$'-)$-!& %,%$'! ',(5,"#)*$((5$ #!$-$(5$%!d$/ -,-,"')r($ ;=@)- 'r!",r d! 4$r!($( '$r).K)"$( TB d$'$% %,%$' *!d)' d$( ",(,%$'-,$"$ #,r%$*)(9%$*)( d$$" /,,(4$r !(!&%,%$'! %!d$/ ",(!"#)/$( ,4$$ TB.

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    K="',/- 'r!",r d$'$% 4)$ ",($$"! /="'!/$-!.K="'!/$-! 5$( %,r4$d! d$'$% d!-,#$#/$( =,* ;=@)-

    '$r) $%$) d! /,,(4$r !";, r,!=($. F=/)- 'r!",r d! '$r) d$'$% ","#,-$r d$(

    ",(5,#$#/$( (neum&nitis $%$) (leuritis )&kal.

    K,,(4$r !";, *!)- $%$) '$r$%r$/,$ 5$( ")$(5$#,r)/)r$( (=r"$ -$$% $$ !(;,/-!& $/$( ","#,-$r/$r,($ r,$/-! !(Q$"$-! 5$( #,r$(4)%. Br=(/)- d$'$%%,r$(). O#-%r)/-! '$r-!$ '$d$ #r=(/)- $/!#$%%,/$($( ,/-%,r($ d$'$% ",(5,#$#/$( ateletaksis.K,,(4$r 5$( ",($$"! !(Q$"$-! d$( (,/r=-!-

    ',r/!4)$( d$'$% ",r)-$/ d$( ",(!"#)/$( ,r=-! d!(d!(#r=(/)-& -,*!($ ",(5,#$#/$( TB ,(d=#r=(/!$ $%$)","#,(%)/ H-%)$. M$--$ /!4) d$'$% ",(!"#)/$(=#-%r)/-! /="'!% '$d$ #r=(/)- -,*!($ ",(5,#$#/$($#)($( '(,)"=(!%!- d$( $%,,%$/-!-& 5$( -,r!(

    d!-,#)% -,#$$! lesi segmental k&la(s*k&ns&li+asi'

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    S,$"$ "$-$ !(/)#$-!& -,#,)" %,r#,(%)/(5$!")(!%$- -,),r& d$'$% %,r4$d! ',(5,#$r$( lim)&gend$( hemat&gen. P$d$ ',(5,#$r$( !";=,(& /)"$(

    ",(5,#$r /, /,,(4$r !";, r,!=($ ","#,(%)//="',/- 'r!",r. S,d$(/$( '$d$ ',(5,#$r$(*,"$%=,(& /)"$( TB "$-)/ /, d$$" -!r/)$-!d$r$* d$( ",(5,#$r /, -,)r)* %)#)*. Ad$(5$

    ',(5,#$r$( *,"$%=,( !(!$* 5$( ",(5,#$#/$( TBd!-,#)% -,#$$! ',(5$/!% -!-%,"!/.

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    P,(5,#$r$( *$"$%=,( 5$( '$!( -,r!( %,r4$d! $d$$*

    d$$" #,(%)/ ',(5,#$r$( *,"$%=,(!/ %,r-$"$r ,occulthamatogenic spread -' M,$)! @$r$ !(!& /)"$( TB

    ",(5,#$r -,@$r$ -'=r$d!@ d$( -,d!/!% d,"! -,d!/!%-,*!($ %!d$/ ",(!"#)/$( ,4$$ /!(!-. K)"$( TB/,")d!$( $/$( ",(@$'$! #,r#$$! =r$( d! -,)r)* %)#)*.Or$( 5$( #!$-$(5$ d!%)4) $d$$* =r$( 5$( ","')(5$!C$-/)$r!-$-! #$!/& "!-$(5$ =%$/& %)$(& !(4$& d$( '$r)

    -,(d!r!& %,r)%$"$ $',/- '$r) $%$) =#)- $%$- '$r). P$d$)")"(5$ & /)"$( d!-$r$( %,r-,#)% %,%$' *!d)'& %,%$'!%!d$/ $/%!;. S$r$( d! $',/- #$r) d!-,#)% d,($( ;=/)-S!"=(& 5$( /,")d!$( *$r! d$'$% ",($$"! r,$/%!C$-!d$( %,r4$d! TB $',/- '$r) -$$% d,$-$.

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    B,(%)/ ',(5,#$r$( *$"$%=,( 5$( $!( $d$$*',(5,#$r$( *,"$%=,(!/ ,(,r$!-$%$ $/)% ,acutegeneralized hematogenic spread -' P$d$ #,(%)/ !(!&

    -,4)"$* #,-$r /)"$( TB "$-)/ d$( #,r,d$r d$$"d$r$* ",()4) /, -,)r)* %)#)*. $ !(! d$'$%",(5,#$#/$( %!"#)(5$ "$(!;,-%$-! /!(!- ',(5$/!% TB-,@$r$ $/)%& 5$( d!-,#)% T +iseminata. TBd!-,"!($%$ !(! %!"#) d$$" $/%) 29? #)$( -,%,$*

    %,r4$d! !(;,/-!. T!"#)(5$ ',(5$/!% #,r$(%)( '$d$ 4)"$* d$( C!r),(-! /)"$( TB 5$( #,r,d$r -,r%$;r,/),(-! #,r)$((5$ ',(5,#$r$(. T)#,r/)=-!-d!-,"!($%$ %,r4$d! /$r,($ %!d$/ $d,/)$%(5$ -5-%," !")(',4$") 6*=-% d$$" ",($%$-! !(;,/-! TB& "!-$(5$

    '$d$ #$!%$& %,r)%$"$ d!#$$* )")r 2 %$*)(.

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     T)#,r/)=-!- "!!,r ",r)'$/$( *$-! d$r! acute

    generalized hematogenic spread  d,($( 4)"$*/)"$( 5$( #,-$r. K)"$( ",(,5,#$r /, -,)r)*

    %)#)*& d$$" ',r4$$((5$ d!d$$" ',"#))* d$r$*$/$( %,r-$(/)% d!)4)( /$'!,r& d$( $/$(",",#,(%)/ %)#,r/,. S,")$ %)#,r/, 5$(d!*$-!/$( ",$)! @$r$ !(! $/$( ","')(5$! )/)r$(

    5$( ,#!* /)r$( -$"$. I-%!$* "!!,r #,r$-$ d$r!$"#$r$( ,-! d!-,"!($%$ 5$( ",(5,r)'$! #)%!r'$d!9'$d!$(

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    B,(%)/ ',(5,#$r$( *,"$%=,( 5$( 4$r$(

    %,r4$d! $d$$* protracted hematogenic spread ' B,(%)/ ',(5,#$r$( !(! %,r4$d! #!$

    -)$%) ;=@)- ',r/!4)$( ",(5,#$r /, -$)r$(C$-@)$r d! d,/$%(5$& -,*!($ -,4)"$*/)"$( TB $/$( "$-)/ d$( #,r,d$r d! d$$"d$r$*. S,@$r$ /!(!-& -$/!% TB $/!#$%

    ',(5,#$r$( %!', !(! %!d$/ d$'$% d!#,d$/$(d,($( acute generalized hematogenicspread. $ !(! d$'$% %,r4$d! -,@$r$ #,r)$(.

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    P,r4$$($( $$"!$*

     TB

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    S)"#,r ',()$r$( $d$$* '$-!,( TB '$r) BTA '=-!%!;& #$!/

    d,$-$ "$)')( $($/.

    A($/ 5$( %,r/,($ TB %!d$/ -,$) ",()$r/$( '$d$ =r$(d! -,/!%$r(5$& /,@)$! $($/ %,r-,#)% BTA '=-!%!; $%$)",(d,r!%$ $d)% %5', TB.

     F$/%=r r!-!/= ',()$r$( TB '$d$ $($/ %,r$(%)( d$r!%!(/$% ',()$r$(& $"$ '$4$($(& d$5$ %$*$( '$d$ $($/.P$-!,( TB d,($( BTA '=-!%!; ","#,r!/$( /,")(/!($(r!-!/= ',()$r$( ,#!* #,-$r d$r!'$d$ '$-!,( TB d,($(BTA (,$%!;.

    P$-!,( TB d,($( BTA (,$%!; "$-!* ","!!/! /,")(/!($(",()$r/$( ',(5$/!% TB. T!(/$% ',()$r$( '$-!,( TB BTA'=-!%!; $d$$* ?& '$-!,( TB BTA (,$%!; d,($( *$-!/)%)r '=-!%!; $d$$* 2? -,d$(/$( '$-!,( TB d,($(*$-! /)%)r (,$%!; d$( ;=%= T=r$/- '=-!%!; $d$$* 17.

    >$r$ ',()$r$( %)#,r/)=-!- :

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    D!$(=-!- '$-%! TB d!%,$//$( d,($( d!%,")/$((5$

    M. T)#,r@)=-!- '$d$ ',",r!/-$$( -')%)"& #!$-$"#)(& @$!r$( -,r,#r=-'!($ 6>SS& @$!r$ ',)r$

    $%$) #!='-! 4$r!($(. P$d$ $($/& /,-)!%$( ",(,$//$( d!$(=-!-'$-%!

    d!-,#$#/$( /$r,($ d)$ *$ :

    1. S,d!/!%(5$ 4)"$* /)"$( 6'$)@!#$@!$r5& /$r,($/,r)-$/$( 4$r!($( TB '$r) 'r!",r %,r,%$/

    d!/,,(4$r ,";, *!)- d$( '$r,(/!" '$r) #$!$(',r!;,r d$( /,r)-$/$( '$r,(/!" '$r) %!d$/ -,#,r$%=r$( d,$-$. B$-! %$*$( $-$" #$r) d$'$% d!!*$%d,($( "!/r=-/=' #!$ 4)"$*(5$ '$!( -,d!/!%.000 /)"$( d$$" 1 " -',-!",(.

    D!$(=-!- T)#,r/)=-!- '$d$

    $($/

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    2. S)!%(5$ ",$/)/$( ',($"#!$( -',-!",(&/$r,($ =/$-! /,$!($((5$ d!',r,(/!" %!d$/

    #,r*)#)($( d,($( $(-)( d,($( #r=(/)-&"$/$ 'r=d)/-! -')%)" "!(!"$< %!d$/ $d$. -')%)"5$( r,'r,-,(%$%!; )(%)/ d!$/)/$( ',",r!/-$$("!/r=-/='!- $d$$* -')%)" 5$( /,(%$ d$( ')r),(&#,r$r($ *!4$) /,/)(!($( d,($( C=)", 39 ".

    W$$)')( #$%)/(5$ #,rd$*$/ & '$d$ $($/ #!$-$(5$d$*$/ $/$( d!%,$(& -,*!($ d!',r)/$( #!$-$"#)( 5$( d!$"#! ",$)! ($-=$-%r!/ %)#,6NGT d$( @$r$ !(! ","#)$% '$-!,( %!d$/ (5$"$(.

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    B,#,r$'$ $$-$( %,r-,#)% ",(5,#$#/$(

    d!$(=-!- TB $($/ %,r)%$"$ d!d$-$r/$( '$d$

    ',(,")$( /!(!- d$( r$d!==!-& 5$( /,d)$(5$-,r!( %!d$/ -',-!H/.

    D!$(=-!- TB d!%,(%)/$( #,rd$-$r/$( $"#$r$(/!(!- d$( ',",r!/-$$( ',()(4$( -,',r%! )4!%)#,r/)!(& ;*=%= %*=r$& d$( ',",r!/-$$($#=r$%=r!)". Ad$(5$ r!$5$% /=(%$/ d,($('$-!,( TB d,$-$ BTA '=-!%!;& )4! %)#,r/)!('=-!%!;& ,4$$ d$( %$(d$ -),-%!; TB d$( ;*%=%*=r$ ",($r$* '$d$ TB 6-),-%!; TB.

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    M$(!;,-%$-! /!(!- TB %,r#$! d)$ :

    1. M$(!;,-%$-! -!-%,"!/

    D,"$" & %,")$( d,"$" '$d$ TB #,r/!-$r$(%$r$ 0980 /$-)-. D,"$" #!$-$(5$ %!d$/%!(! d$( *!$( %!"#) d$$" 4$(/$ $/%)5$( @)/)' $"$. M$(!;,-%$-! -!-%,"!/ $!( 5$(

    -,r!( d!4)"'$! $d$$* $(=r,/-!$& #,r$% #$d$(%!d$/ ($!/ 6%)r)(& %,%$'& ($!/ %,%$'! %!d$/ -,-)$!d,($( r$H/ %)"#)*& "$$!-, 6,%!*& ,-)&,"$* & ,$*.

    M$(!;,-%$-! /!(!- TB

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    2. M$(!;,-%$-! -',-!H/

     T,r$(%)( =r$( 5$( %,r/,($& "!-$(5$ /,,(4$r

    !";,& -)-)($( -$r$; ')-$% 6SSP& %)$(& /)!%. K,,(4$r !";,

    P,",#,-$r$( /,,(4$r !";, -)',H-!-$!- -,#$$!"$(!;,-%$-! TB %,r-,r!( d!4)"'$!. K,,(4$r 5$(

    -,r!( %,r/,($ $d$$* /,,(4$r !";, /=! $(%,r!=r$%$) '=-%,r!=r& %,%$'! 4)$ d$'$% %,r4$d! d!$/-!$&!()!($& -)#"$(d!#)$&d$( -)'r$/$C!/)$. S,@$r$/!(!- /$r$/%,r!-%!/ /,,(4$r d$'$% d!4)"'$! ")%!',&)(!$%,r$& %!d$/ (5,r! %,/$(& %!d$/ *$($% '$d$

    ',r$#$$(& ")d$* d!,r$//$(& d$( d$'$% -$!(",,/$% 6@=(Q),(@, -$%) -$"$ $!(.

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    S)-)($( -$r$; ')-$% 6SSP

     TB %,r-,r!( '$d$ SSP $d$$* ",(!(!%!-. P,(5$/!%!(! ",r)'$/$( ',(5$/!% 5$( #,r$% d,($("=r%$!%$- d$( /,@$@$%$( 5$( %!(!. G,4$$ /!(!-#,r)'$ (5,r! /,'$$& ',()r)($( /,-$d$r$(& /$/)/)d)/& ")(%$* 'r=5,/%! d$( /,4$(.

    S!-%," -/,,%$

    G,4$$ )")" 5$( -,r!( d!%,")/$( $d$$* (5,r!&#,(/$/ '$d$ -,(d! 5$( %,r/,($& d$( $()$(/,%,r#$%$-$( ,r$/. P$d$ #$5! d$( $($/ 5$(-,d$( d$$" "$-$ ',r%)"#)*$( & ,'!H-!- %)$(

    ",r)'$/$( d$,r$* d,($( C$-/)$r!-$! %!(! 5$(d!-)/$! =,* /)"$( TB. %TB -!-%," -/,,%$ 5$(-,r!( %,r4$d! $d$$* -'=(d!!%!- TB& /=/-!%!- TB&=(!%!- TB.

    !

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    K)!%

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