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BAGIAN ILMU BEDAH
FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDDIN
CASE PRESENTATION
SEPTEMBER 2013
KOLESISTOLITIASIS
OLEH :
M. KHUSMAN JAYA SAHIR
110.205.0138
PEMBIMBING :
Dr. ARWI AMIRUDDIN
SUPERVISOR :
Dr. MURNY A. RAUF, Sp.B-KBD (K)
DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK
DI BAGIAN ILMU BEDAH SUBDIVISI BEDAH DIGESTIF
FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
MAKASSAR
2013
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LEMBAR PENGESAHAN
Yan !"r#an$a #anan $%!a&a' %n% "na#a*an !a'&a a'a+%+&a an !"r+an*#an
+"!aa% !"r%*#
Naa M. KHUSMAN JAYA SAHIR
NIM 110.205.0138
"/a' "n"/"+a%*an a+" r"+"n#a#%n $"nan $/ K/"+%+#/%#%a+%+, +"!aa% #a+
*"pan%#"raan */%n%* pa$a Ba%an I/ B"$a' $% Fa*/#a+ K"$*#"ran Un%4"r+%#a+
Ha+an$$%n.
MAKASSAR, SMBR 2013
M"n"#a'%,
Super!"#r
Dr. MURNY A. RAUF , Sp.B -KBD (K)
Pe$%!$%!&'
Dr. ARWI AMIRUDDIN
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CASE PRESENTATION
Ba%an I/ B"$a' D%"+#%6 Fa*/#a+ K"$*#"ran Un%4"r+%#a+ Ha+an$$%n Ma*a++ar
I( IDENTITAS PASIEN
Naa "n$"r%#a Nr'aa#%
K"/a%n "r"pan
Aaa I+/a
Ur 32 a'n
N.R"%+#"r RS 72.08.15
ana/ MRS 2082013
A/aa# B !/* A n 179
Ranan :n#ara 2 !"$a' $%"+#%6 *aar 1
II( FOTO KLINIS
III( AUTOANAMNESIS
)( Ke*u+)& U,)$) N"r% p"r# *anan a#a+
%( A&)$&e"!" Terp!$p!&
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a+%"n $a#an $"nan *"/'an n"r% p"r# *anan a#a+ an $%ra+a*an 5 a
+"!"/ a+* ra' +a*%#. N"r% p"r# *anan a#a+ $% a/a% +"a* 1 #a'n
an /a/ +"p"r#% $% #+*, n"r% '%/an #%!/ $an #%$a* #"r+-"n"r+, n"r%
$%ra+a*an $ar% p"r# *anan a#a+ '%na !a%an / 'a#% nan #%$a* "na/ar
+apa% *" !a' *anan $an pnn. J%*a n"r% n;/ #%$a* $apa#
"/a**an a*#%4%#a+ apapn. a+%"n !%a+ana 'ana !"r!ar%n $% #"pa#
#%$r %*a +"ranan n"r% $a#an. Na6+ a*an pa+%"n a "nrn
+""na* +a*%#.
R%&aa# a/ (a$a) n#a' (a$a), 6r"*"n+% 1*a/% %+% +%+a a*anan +"a*
*ran /"!%' 5 a +"!"/ a+* ra' +a*%#.
R%&aa# BAB (a$a) !%a+a
R%&aa# BAK (a$a) !%a+a
R%&aa# +"r%n *n++% a*anan !"r/"a* (a$a)
R%&aa# D"a (#%$a* a$a)
R%&aa# Ba#* (#%$a* a$a)
R%&aa# +"+a* na6a+ (#%$a* a$a)
R%&aa# p"na*%# *n%n (#%$a* a$a)
R%&aa# Maa (#%$a* a$a)
R%&aa# A/"r% (#%$a* a$a) #"r'a$ap !a#-!a#an $an a*anan #"r#"n#.
IV( PEMERIKSAAN FISIS
S,),u" Ge&er)*!"),) Sa*%# S"$an
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N 80 *a/%"n%# r"/ar, *a# an*a#
20 *a/%"n%# +pn#an, #%p" #'ra;a!$%na/
S 37 0 +' a>%//a
S,),u" Re'!#&)* :
Kep)*)
B"n#* $an *ran *"pa/a Nr+"6a/%
Ra!# H%#a, /r+, +*ar $%;a!#
Ma#a An"%+ (#%$a* a$a), %*#"r+ (#%$a* a$a)
"/%na ?#r" (#%$a* a$a), p"r$ara'an (#%$a* a$a)
H%$n p%+#a*+%+ (#%$a* a$a), $"6r%#a+ (#%$a* a$a)
B%!%r S%an+%+ (#%$a* a$a)
:%$a' K#r (#%$a* a$a),;an$%$%a+%+ (#%$a* a$a)
Le+er
In+p"*+% Warna */%# +aa $"nan +"*%#ar, #%$a* #apa* a++a #r
a/pa+% "!"+aran *"/"nar "#a' !"n%n (#%$a* a$a), n"r% #"*an
(#%$a* a$a), *a* *$* (#%$a* a$a)
T+#r)-
In+p"*+% S%"#r%+ *%r% +aa $"nan *anan, #%p" p"rna6a+an
#'ra*a!$%na/
a/pa+% Ma+a r (#%$a* a$a), N"r% "*an (#%$a* a$a), 4*a/
6r"%#+ *%r% +aa $"nan *anan
"r*+% Snr *%r% +aa $"nan *anan
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A+*/#a+% Bn% ar 4"+%*/"r, Bn% a!a'an Rn*'% (#%$a*
a$a#%$a* a$a), W'"=%n (#%$a* a$a#%$a* a$a)
.)&,u&'
In+p"*+% I;#+ r$%+ #%$a* #apa*
a/pa+% I;#+ r$%+ #%$a* #"ra!a
"r*+% "*a*, !a#a+ an#n $a/a !a#a+ nra/
A+*/#a+% Bn% Jan#n III rn% r"/ar, !n% #a!a'an (#%$a*
a$a)
Ver,e%r)
In+p"*+% A/%n"n# #/an !a%*, #%$a* #apa* a++a #r. &arna
*/%# +aa $"nan +"*%#arna.
a/pa+% #%$a* #"ra!a a++a #r.
E/",re$!,)"
E/",re$!,)" "uper!#r /)&)& )& /!r! :
In+p"*+% #%$a* $%#"*an *"/a%nan
a/pa+% #%$a* $%#"*an *"/a%nan
E/",re$!,)" !&er!#r /)&)& )& /!r!
In+p"*+% #%$a* $%#"*an *"/a%nan
a/pa+% #%$a* $%#"*an *"/a%nan
S,),u" L#/)*!" :
Re'!# A%#$e&
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In+p"*+% "!n %*# "ra* napa+, $ar ;n#r (#%$a* a$a),
$ar +#"%6n (#%$a* a$a)
A+*/#a+% "r%+#a/#%* (a$a) *"+an nra/
a/pa+% N"r% #"*an (a$a) pa$a '%p*n$r% $">#ra, a++a
#r (#%$a* a$a), H"par/%"n (#%$a* #"ra!a).
"r*+% %pan% (a$a) *"+an nra/, +'%6#%n $//n"++ (#%$a* a$a)
V( PEMERIKSAAN PENUN.ANG
)( L)%#r),#r!u$
D)r)+ ru,!& 2405420136
PARAMETER NILAI RU.UKAN
WB 9,@7 @,00 -10,00
RB 5,02 @,00 - 7,00
H
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K!$!) /*!&!/ 2 405 420136
PARAMETER NILAI
RU.UKAN
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%$a* #apa* pr+"+ +p"+%6%* pa$a *"$a par
r $a/a !a#a+ nra/, ar#a nra/
K"$a +%n+ $an $%a6raa !a%*
/an-#/an %n#a*
Ke")& : T!)/ ,)$p)/ /e*)!&)& r)!#*#'!/ p)) #,# ,+#r)/" !&!(
F#,# USG ABDOMEN T)&'')* 2 49 420136
- Hep)r H"par #%$a* "!"+ar, p"r*aan r"/"r, #%p #aa, ";'
par"n*% $a/a !a#a+ nra/, #%$a* #apa* S?:. S%+#" 4a+*/"r $an
!%/%ar%+ #%$a* $%/a#a+%.
- GB $%n$%n #%$a* "n"!a/< ,)$p)/ e=+# )=u",!= "+)#>6 %),u
!)*)$&?) e&')& u/ur)& 1
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- L!e& %$a* "!"+ar, ";' par"n*% nra/ '"n, #%$a* #apa*
S?:.
- G!&)* /)&)& B"n#* $an *ran $a/a !a#a+ nra/, ";' par"n*%
nra/, #%$a* #apa* ";' !a# apn S?:. "/4;a/;"a/ ++#" #%$a*
$%/a#a+%.
- G!&)* /!r! B"n#* $an *ran $a/a !a#a+ nra/, ";' par"n*%
nra/, #%$a* #apa* ";' !a# apn S?:. "/4;a/;"a/ ++#" #%$a*
$%/a#a+%.
- VU M*+a r"/"r $an #%$a* "n"!a/, #%$a* #apa* ";' !a# apn
a++a
Ke")& : C+#*e*!,+
VI( RESUME
a+%"n p"r"pan, 32 #a'n, a+* ra' +a*%# $"nan *"/'an n"r% p"r#
*anan a#a+ +"a* 5 a SMRS, N"r% $%a/a%+"a* 1 #a'n an /a/ nan
'%/an #%!/ $an #%$a* #"r+-"n"r+ n"r%. N"r% $%ra+a*an $ar% p"r# *anan
a#a+ '%na !a%an / 'a#% nan #%$a* "na/ar +apa% *" !a' *anan $an
pnn. R%&aa# a/ (a$a) n#a' (a$a), 6r"*"n+% 1*a/% %+% +%+a a*anan
+"a* *ran /"!%' 5 a +"!"/ a+* ra' +a*%#. R%&aa# BAB (a$a)
!%a+a, R%&aa# BAK (a$a) !%a+a, R%&aa# +"r%n *n++% a*anan !"r/"a*
(a$a), R%&aa# D"a (#%$a* a$a), R%&aa# Ba#* (#%$a* a$a), R%&aa# +"+a*
na6a+ (#%$a* a$a), R%&aa# p"na*%# *n%n (#%$a* a$a), R%&aa# Maa (#%$a*
a$a), R%&aa# A/"r% (#%$a* a$a) #"r'a$ap !a#-!a#an $an a*anan #"r#"n#.
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a$a p""r%*+aan 6%+%* $%$apa#*an $%#"*an n"r% #"*an (a$a) pa$a
'%p*n$r% $">#ra. a$a p""r%*+aan US<
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!a# "p"$ *ar"na p"nar' 'rn "+#r"n. Fa*#r /a%n an "n%n*a#*an
r"+%* #"ra$%na !a# "p"$ an#ara /a%n a%# !"+%#a+, a*anan, r%&aa# *"/ara,
a*#%6%#a+ 6%+%*, $an n#r%+% an*a 4"na an /aa.
M"+*% &an%#a $an +%a @0#' #"r;a#a# +"!aa% 6a*#r r%+%* !a# "p"$, %#
#%$a* !"rar#% !a'&a &an%#a $% !a&a' @0#' $an pr%a #%$a* n*%n #"r*"na. "n$"r%#a
$%a!"#"+ "//%#+ (DM), !a%* &an%#a apn pr%a, !"r%+%* "na/a% *p/%*a+%
!a# "p"$ a*%!a# */"+#"r/ #%n%. Ba'*an, ana*-ana* a !%+a "na/a%na,
#"r#aa ana* $"nan p"na*%# */"+#"r/ '"r"$%#"r.2,3
M"nr# a!aran a*r+*p%* $an *p+%+% *%%ana, !a# "p"$ $apa#
$%*/a+%6%*a+%*an "na$% #%a *a#"r% ar, a%#
1. Ba# */"+#"r/ $%ana *p+%+% */"+#"r/ "/"!%'% 90,
2.Ba# p%"n ;*/a# a#a !a# ;a/;% !%/%r!%na#" an "nan$n
;a/+% !%/%r!%na#" +"!aa% *pn"n #aa, $an
3. Ba# p%"n '%#a an *aa a*an r"+%$ '%#a #a* #"r"*+#ra*+%. 1
Ba# *an$n "p"$ !%a+ana !ar "n%!/*an "a/a $an *"/'an !%/a
!a# "n!a# $*#+ +%+#%*+ a#a $*#+ */"$*+. ?/"' *ar"na %# a!aran
*/%n%+ p"n$"r%#a !a# *an$n "p"$ !"r4ar%a+% $ar% an !"ra# a#a "/a+ +apa%
an r%nan a#a +aar !a'*an +"r%n *a/% #anpa "a/a (+%/"n# +#n").
K"!ana*an !a# $*#+ */"$*+ !"ra+a/ $ar% !a# *an$n "p"$, #"#ap%
a$a a an #"r!"n#* pr%"r $% $a/a +a/ran "p"$ "*+#ra'"pa#%* apn
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%n#ra'"pa#%*. S"!a%an !"+ar pa+%"n $"nan !a# *an$n "p"$ #%$a* "na/a%
"a/a a#a a+%p#a#%+.
1
Wa/apn !a# $apa# #"ra$% $%ana +aa $a/a +a/ran "p"$, nan !a#
*an$n "p"$ %a/a' an #"r+"r%n $%$apa#. B%/a !a# "p"$ %n% #"#ap +aa #%na/
$% $a/a *an$n "p"$, a*a !%a+ana #%$a* "n%!/*an "a/a apapn.
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"p"$ "na$% *"n#a/ $an !"r&arna ;*/a# #a (!%/%ar $). D%n$%n $ar%
$*#+ */"$*+ "n"!a/ $an "na/a% $%/a#a+% $%+"r#a% $"nan /+"ra+% pa$a
*+a #"r#aa $% +"*%#ar /"#a* !a# $an $% ap/a 4a#"r%.
D"nan p"r*"!anan p"ra/a#an $an #"*n%* $%an+%+ an !ar US
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BAB II
TIN.AUAN PUSTAKA
1( Dee&!"!
K/"/%#%a+%+ (*a/*/%*a/*/+, !a# "p"$) "rpa*an +a# *"a$aan
$%ana #"r$apa#na !a# "p"$ $% $a/a *an$n "p"$ (4"+%;a 6"//"a)
an "%/%*% *ran, !"n#* $an *p+%+% an !"r4ar%a+%.9
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Kapa+%#a+na +"*%#ar 30-50 ;; $an $a/a *"a$aan #"r!+#r*+% $apa# "n"!n
+apa% 300 ;;.
p"$ an $% +"*r"+% +";ara #"r+ "n"r+ /"' 'a#% a+* *" +a/ran
"p"$ an *";%/ $a/a 'a#%. Sa/ran "p"$ an *";%/ !"r+a# "!"n#* $a
+a/ran an /"!%' !"+ar an *"/ar $ar% p"r*aan 'a#% +"!aa% $*#+ '"pa#%*+
*n%+.
Fn+% "p"$ a$a/a' n#* "n"n#a/*an $an "n%pan "p"$ an
$%!a&a $ar% '"par "/a/% $;#+ ;+#%*+ $%an#ara &a*# a*an $an "/"pa+*an
"p"$ *" $a/a ++ /"&a# $;#+ ;+#%*+ +"/aa a*an.8
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$%/an#*an +"!aa% $*#+ ;+#%;+ an !"ra/an $a/a "n# %n+ n#*
!"r+a# $"nan +%+% *anan $;#+ '"pa#%;+ ;n%+ "!"n#* $*#+ */"$*+.
"r%#n" "n"/%/%n% 6n$+ 4"+%;a 6"//"a $"nan +"prna "n'!n*an
;rp+ $an ;// $"nan p"r*aan 4%+;"ra/ 'a#%.
"!/' ar#"r% *an$n "p"$ a$a/a' ar#"r% ;+#%;a, ;a!an ar#"r% '"pa#%;a
*anan. "na ;+#%;a "na/%r*an $ara' /an+n *"$a/a 4"na pr#a. S"/a' ar#"r%
an +ana# *";%/ $an 4"na 4"na a !"ra/an an#ara 'a#% $an *an$n "p"$.
#"r ar#"r%a '"pa#%;a prpr%a
Ba%an r";# $$"na/ $%pa+* /"' ar#"r%a pan;r"a#%; $$"na/%+ +p"r%r
p+#"r%r $an ar#"r%a a+#r$$"na/%+
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Ar#"r%a ;+#%;a "nan#ar $ara' *"pa$a $;#+ ;'/"$;'+ $an $;#+
;+#%;+. Ar#"r%a ;+#%;a !%a+ana !"ra+a/ $ar% ra+ $">#"r ar#"r%a '"pa#%;a prpr%a $%
+$# an#ara $;#+ '"pa#%;+ ;n%+ $an $;#+ ;+#%;+.8
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Fn+% pr%"r $ar% *an$n "p"$ a$a/a' ""*a#*an "p"$ $"nan
a!+rp+% a%r $an na#r%. Kan$n "p"$ ap ""*a#*an =a# #"r/ar# an
*"$ap, an #"r*an$n $a/a "p"$ '"pa#%* 5-10 *a/% $an "nran% 4/"na
80-0.8
M"nr#
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"p"$. S#a+%+ "p"$ $a/a *an$n "p"$ $apa# "n%n*a#*an +p"r+a#ra+%
pr"+%6, p"r!a'an ++nan *%%a, $an p"n"n$apan n+r #"r+"!#. In6"*+% !a*#"r%
$a/a +a/ran "p"$ $apa# !"rp"ran +"!a%an $a/a p"!"n#*an !a#, "/a/%
p"n%n*a#an $an $"+*aa+% +"/ $an p"!"n#*an *+.1,8
S"*r"+% */"+#"r/ !"r'!nan $"nan p"!"n#*an !a# "p"$. a$a
*n$%+% an a!nra/, */"+#"r/ $apa# "n"n$ap, "n"!a!*an p"!"n#*an
!a# "p"$. B"r!aa% *n$%+% an $apa# "n"!a!*an p"n"n$apan */"+#"r/
a$a/a' #"r/a/ !ana* a!+r!+% a%r $ar% "p"$, #"r/a/ !ana* a!+r!+% ara-
ara "p"$ $an /"+%#%n $ar% "p"$, $an #"r/a/ !ana* +"*r"+% */"+#"r/ $a/a
"p"$.
J/a' */"+#"r/ $a/a "p"$ +"!a%an $%#"n#*an /"' /a' /"a* an
$%a*an *ar"na +"/-+"/ '"pa#%* "n+%n#"+%+ */"+#"r/ +"!aa% +a/a' +a# pr$*
"#a!/%+" /"a* $a/a #!'. Un#* a/a+an %n%/a', ran an "n$apa# $%"#
#%n% /"a* $a/a &a*# !"!"rapa #a'n, a*an $a' "na/a% p"r*"!anan
!a# "p"$.7
Ba# *an$n "p"$ $apa# !"rp%n$a' *"$a/a $*#+ */"$*+ "/a/%
$*#+ +%+#%*+. D%$a/a p"ra/ananna "/a/% $*#+ +%+#%*+, !a# #"r+"!#
$apa# "n%!/*an +!a#an a/%ran "p"$ +";ara par+%a/ a#a *p/"# +"'%na
"n%!/*an "a/a */%* "p"$. Ka/a !a# #"r'"n#% $%$a/a $*#+ +%+#%*+
*ar"na $%a"#"rna #"r/a/ !"+ar a#a #"r#a'an /"' +#r%*#r, !a# a*an #"#ap !"ra$a
$%+ana +"!aa% !a# $*#+ +%+#%*+.1,9,8
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8( P),#!"!#*#'!
)(Ba# K/"+#"r/
Ba# */"+#"r/ "nan$n pa/%n +"$%*%# 90 */"+#"r/, $an +%+ana a$a/a'
*a/+% *ar!na#, *a/+% pa/%#%#, $an *a/+% !%/%r!%na#. B"n#*na /"!%'
!"r4ar%a+% $%!an$%n*an !"n#* !a# p%"n. "r!"n#*na 'ap%r +"/a/ $% $a/a
*an$n "p"$, $apa# !"rpa +/%#"r a#a /#%p"/. "r*aanna n*%n /%;%n
a#a /#%6a+"#, !/a#, !"r$r%, $an a$a an +"p"r#% !a' r!"%.3,2 Ba# K/"+#"r/
#"ra$% *"r"na *n+"n#ra+% */"+#"r/ $% $a/a ;a%ran "p"$ #%n%. In% a*%!a# $ar%
*/"+#"r/ $% $a/a $ara' ;*p #%n%. J%*a */"+#"r/ $a/a *an#n "p"$ #%n%,
p"n"n$apan a*an #"ra$% $an /aa *"/aaan "na$% !a#. "n"!a! /a%n a$a/a'
p"n+nan ;a%ran "p"$ $% $a/a *an#n "p"$ *ran +"prna, a+%'
a$ana +%+a-+%+a ;a%ran "p"$ $% $a/a *an#n +"#"/a' pr+"+ p"paan "p"$
+"'%na #"ra$% p"n"n$apan.
S%6a# 6%+%*%a "p"$ !"r4ar%a+% +"+a% *n+"n#ra+% r"/a#%6 ara "p"$,
/"+%#%n $an */"+#"r/. K/"+#r/ $%/ar#*an $a/a "p"$ $a/a $a"ra' '%$r6!%*
%;"//", +"'%na *"/ar#anna #"ran#n pa$a /a' r"/a#%6 ara "p"$ $an
/"+%#%n. H!nan an#ara */"+#"r/ /"+%#%n $an ara "p"$ %n% $apa# $%/%'a# $a/a
ra6%* +"%#%a. Yan *r$%na#na "rpa*an p"r+"n#a+% *n+"n#ra+% /ar ara
"p"$, /"+%#%n $an */"+#"r/. p"$ an "nan$n */"+#"r/ +"/r'na $%
$a/a %;"//"+ $%a!ar*an /"' ar"a $% !a&a' ar%+ /"n*n AB (;a%ran
%;"//"), #"#ap% !%/a *n+"n#ra+% r"/a#%6 ara "p"$, /"+%#%n $an */"+#"r/ #rn *"
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ar"a $% a#a+ ar%+ AB, a*a a$a */"+#"r/ $% $a/a $a 6a+" a#a /"!%' (;a%ran
%;"//" $an *r%+#a/ */"+#"r/).
9
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Ba# *a/+% !%/%r!%na# $%nan $an "rpa*an @0 +apa% 70 $ar% +"a
!a# "p"$. Ba# %n% /"!%' rap', !"r&arna *";*/a#an +apa% '%#a. Una
!a# p%"n ;*/a# %n% #"r!"n#* $% +a/ran "p"$ $a/a "p"$ an #"r%n6"*+%.
Ba# p%"n ;*/a# !%a+ana $%#"*an $"nan *ran $%a"#"r *ran $ar% 1 ;,
!"r&arna ;*/a# *"*n%nan, /"!# $an +"r%n $%pa% $% $a"ra' A+%a.
Ba# %n% #"r!"n#* a*%!a# 6a*#r +#a+%+ $an %n6"*+% +a/ran "p"$. S#a+%+ $apa#
$%+"!a!*an *ar"na $%+6n+% +6%n#"r $$%, +#r%*#r, p"ra+% !%/%"r, $an para+%#. a$a
%n6"*+% "p"$, *"/"!%'an a*#%4%#a+ !-/;rn%$a+" !a*#"r% $an an+%a ("n$"n)
""an p"ran *n;% $a/a pa#"n"+%+ !a# p%"n pa$a pa+%"n $% n"ara #%r.
H%$r/%+%+ !%/%r!%n /"' "n=% #"r+"!# a*an "!"n#* !%/%r!%n #a*
#"r*na+% an a*an "n"n$ap +"!aa% ;a/;% !%/%r!%na#". n=% !-
/;rn%$a+" !a*#"r% !"ra+a/ $ar% *an . ;/% $an *an /a%nna $% +a/ran
"p"$. n=% %n% $apa# $%'a!a# /"' /;ar/a;#n" an *n+"n#ra+%na
"n%n*a# pa$a pa+%"n $"nan $%"# r"n$a' pr#"%n $an r"n$a' /"a*.1
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=(Ba# p%"n '%#a
Ba# #%p" %n% !ana* $%pa% pa$a pa+%"n $"nan '"/%+%+ *rn%* a#a
+%r+%+ 'a#%. Ba# p%"n %n% #"r#aa #"r$%r% $ar% $"r%4a# p/"r%="$ !%/%r!%n.
a#"n"+%+ #"r!"n#*na !a# p%"n %n% !"/ "/a+. Una !a# p%"n '%#a
#"r!"n#* $a/a *an$n "p"$ $"nan "p"$ an +#"r%/. Ba# "p"$ "n%+ %n%
na !"r*ran *";%/, '%#a $"nan p"r*aan an *a+ar. B%a+ana
!a# p%"n %n% "nan$n *ran $ar% 10 */"+#"r/.10
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n"r% a!$"n *rn%* !"r/an a#apn $%+p"p+%a. S#$% p"ra/anan p"na*%# +apa%
50 $ar% +"a pa+%"n $"nan !a# *an$n "p"$, #anpa "p"r#%!an*an
"n%+na, a$a/a' a+%#a#%*. Kran $ar% 25 $ar% pa+%"n an !"nar-!"nar
"pna% !a# "p"$ a+%#a#%* a*an "ra+a*an "a/ana an "!#'*an
%n#"r4"n+% +"#"/a' p"r%$" &a*# 5 #a'n. %$a* a$a $a#a an "r"*"n$a+%*an
*/"+%+#"*#% r#%n $a/a +"a pa+%"n $"nan !a# "p"$ a+%#a#%*.@
!. S%#a#%*
K"/'an #aana !"rpa n"r% $% $a"ra' "p%a+#r%, *a$ran *anan a#a+.
Ra+a n"r% /a%nna a$a/a' */%* !%/%"r an !"r/an+n /"!%' $ar% 15 "n%#, $an
*a$an !ar "n'%/an !"!"rapa a *"$%an. K/%* !%/%ar%+, n"r% pa+;a pran$%a/
*a$ran *anan a#a+, !%a+ana $%pr"+%p%#a+% /"' a*anan !"r/"a*, #"ra$% 30-70
"n%# +"#"/a' a*an, !"ra*'%r +"#"/a' !"!"rapa a $an *"$%an p/%', $%+"!a!*an
/"' !a# "p"$, $%r* +"!aa% */%* !%/%ar%+. Ma/ $an n#a' +"r%n *a/%
!"r*a%#an $"nan +"ranan */%* !%/%ar%+1,9
;. a+%"n $"nan *p/%*a+% !a# "p"$
K/"+%+#%#%+ a*# "rpa*an *p/%*a+% p"na*%# !a# "p"$ an pa/%n
$an +"r%n ""!a!*an *"$arra#an a!$"n, *'++na $%an#ara &an%#a +%a
p"r#"na'an $an an/a. "ra$anan a*# $ar% *an$n "p"$, !"r*a%#an $"nan
!+#r*+% $*#+ +%+#%*+ a#a $a/a %n6n$%!/.
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'ar;#, $%#a!a' +*, $an *"*a;aan "n#a/ a#a p"nrnan *"+a$aran +apa%
*a.
3
K/"$*/%#%a+%+ +"r%n "n%!/*an a+a/a' an +ana# +"r%+ *ar"na
*p/%*a+% "*an%* $an %n6"*+% an n*%n "nan;a na&a. Ba# $*#+
*/"$*+ $%+"r#a% $"nan !a*#"r!%/%a $a/a 95 p"r+"n pa+%"n +"r#a $"nan a$ana
!+#r*+% +a/ran "p"$, $apa# #%!/ */an%#%+ a*#.
p%+$" para' */an%#%+ a*# $apa# "n"!a!*an a!+"+ 'a#%. M%ra+% !a#
"p"$ *";%/ "/a/% ap/a 4a#"r% +"&a*# a$a +a/ran $%an#ara $*#+
*/"$*+ $%+#a/ $an $*#+ pan*r"a#%*+ $apa# "n"!a!*an pan*r"a#%#%+ !a#
"p"$. "r+an*#na !a# "p"$ $a/a ap/a a*an "n"!a!*an %*#"r+
!+#r*#%6.
D%an+%+ $an p"n"//aan an !a%* $an #"pa# $apa# "n;"a' #"ra$%na
*p/%*a+% an !"ra#. Kp/%*a+% $ar% !a# *an$n "p"$ an#ara /a%n */"+%+#%#%+
a*#, */"+%+#%#%+ *rn%+, */"$*/%#%a+%+, pan*r"a#%#%+, */an%#%+, +%r+%+ !%/%"r
+"*n$"r, %/"+ !a# "p"$, a!+"+ '"pa#%* $an p"r%#n%#%+ *ar"na p"r6ra+% *an$n
"p"$. Kp/%*a+% #"r+"!# a*an "p"r+/%# p"nanananna $an $apa# !"ra*%!a#
6a#a/.9
9( Pe$er!/"))& Pe&u&)&'
a. ""r%*+aan :a!ra#r%
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Ba# *an$n "p"$ an a+%#a#%* na #%$a* "nn**an
*"/a%nan pa$a p""r%*+aan /a!ra#r%. Apa!%/a #"ra$% p"ra$anan a*# $apa#
#"ra$% /"*+%#+%+, !%a+ana a*an $%%*#% *"na%*an r%nan !%/%r!%n +"r a*%!a#
p"n"*anan $*#+ */"$*+ /"' !a#. Ka$ar !%/%r!%n +"r an an #%n%
n*%n $%+"!a!*an /"' !a# $% $a/a $*#+ */"$*+. Ka$ar 6+6a#a+" a/*a/%
+"r $an n*%n *a$ar a/a+" +"r !%a+ana "n%n*a# +"$an +"#%ap *a/%
#"ra$% +"ranan a*#.
!. ""r%*+aan Ra$%/%+
F# p/+ a!$"n !%a+ana #%$a* "!"r%*an a!aran an *'a+ *ar"na
'ana +"*%#ar 10-15 !a# *an$n "p"$ an !"r+%6a# ra$%pa*. Ka$an
*an$n "p"$ an "nan$n "p"$ !"r*a/+% #%n% $apa# $%/%'a# $"nan
6# p/+ a!$"n. a$a p"ra$anan a*# $"nan *an$n "p"$ an "!"+ar
a#a '%$rp+, *an$n "p"$ *a$an #"r/%'a# +"!aa% a++a ar%nan /na*
$%*a$ran *anan a#a+ an "n"*an a!aran $ara $a/a ++ !"+ar, 6/">ra
'"pa#%;a.9,
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!%/%ar%+ /"!%' !a%*. K"*rananna a$a/a' a'a/ $ar% +"% !%aa $an !ana*
"n%!/*an r%+%* !a% pa+%"n. U/#ra+nra6% "pna% $"raa# +p"+%6%+%#a+ $an
+"n+%#%6%#a+ an #%n% n#* "n$"#"*+% !a# *an$n "p"$ $an p"/"!aran +a/ran
"p"$ %n#ra'"pa#%* apn "*+#ra'"pa#%*.
Ja $apa# $%/%'a# $%n$%n *an$n "p"$ an "n"!a/ *ar"na 6%!r+%+ a#a
$" *ar"na p"ra$anan apn +"!a! /a%n. Ba# an #"r$apa# pa$a $*#+
*/"$*+ $%+#a/ *a$an +/%# $%$"#"*+%, *ar"na #"r'a/an $ara $%$a/a ++. D"nan
/#ra+nra6% pn*# a*+% ra+a n"r% pa$a !a# *an$n "p"$ an
anr"n /"!%' "/a+ $ar% pa$a $"nan pa/pa+% !%a+a.
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'"pa#%#%+ *ar"na pa$a *"aa$aan #"r+"!# *n#ra+ #%$a* $apa# "n;apa% 'a#%. "n%/a%an
*/"+%+#ra6% ra/ /"!%' !"ra*na pa$a p"n%/a%an 6n+% *an$n "p"$.
9,
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R %n% "$a'*an 4%+a/%+a+% /an+n +#*#r !%/%"r $an "$a'*an a*+"+ *"
$a/a $*#+ */"$*+ !a%an $%+#a/ n#* "na!%/ !a# "p"$, +"/a%n %#
R !"r6n+% n#* "!"$a*an %*#"r+ an $%+"!a!*an /"' p"na*%# 'a#%,
%*#"r+ '"pa# +"//"r $"nan %*#"r+ an $%+"!a!*an /"' !+#*+% !%/%"r $an a
$apa# $%na*an n#* "n"/%$%*% "a/a a+#r %n#"+#%na/ pa$a pa+%"n-pa+%"n an
*an$n "p"$na +$a' $%an*a#. R %n% !"r%+%* #"ra$%na #an$a-#an$a
p"r6ra+% a#a %n6"*+%.9,
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M"#$" %n% $%$a+ar*an pa$a pr%n+%p ("r;#an"+ #ran+'"pa#%;
;'/an%ra) $an %n+#%/a+% /an+n p"/ar# */"+#"r/ *"*an$n "p"$.
M"+*%pn p"na/aan a+%' #"r!a#a+, %n6+ p"/ar# */"+#"r/ an p#"n ( "#%/-#"r-
!#%/-"#"r (MB) ) *" $a/a *an$n "p"$ "/a/% *a#"#"r an $%/"#a**an
p"r*#an #"/a' #"r/%'a# "6"*#%6 $a/a "/ar#*an !a# "p"$ pa$a pa+%"n-pa+%"n
#"r#"n#. r+"$r %n% %n4a+%6 $an *"r%an #aana a$a/a' an*a *"*a!'an an
#%n%.2
=6(:%##r%p+% (>#ar;r4ra/ S';* Wa4" :%#'#r%p+ O SW:)
:%##r%p+% "/!an "/"*#r +* "+*%pn +ana# pp/"r !"!"rapa #a'n
an /a/, ana/%+%+ !%aa an6aa# pa$a +aa# %n% 'ana #"r!a#a+ n#* pa+%"n an
!"nar-!"nar #"/a' $%p"r#%!an*an n#* "na/an% #"rap% %n%. 6"*#%6%#a+ SW:
""r/*an #"rap% a$4an# a+a r+$"*+%/a#.10
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M$%6%*a+% $ar% #%n$a*an */"+%+#"*#% #"r!*a $"nan %n+%+% /"!%' *";%/
$"nan "6"* n"r% pa+;a p"ra+% /"!%' r"n$a'.
1,7
( Pr#'"!"
a$a */"+%+#/%#%a+%+ +"n$%r% #%$a* p"r/ $%'!n*an $"nan "n%n*a#na
*"a#%an a#a $%#an$a% $"nan *";a;a#an. Baa%anapn !%+a $%+"!a!*an *ar"na
a$ana *p/%*a+%. Ja$% prn+%+ */"+%+#/%#%a+%+ #"ran#n $ar% a$a a#a #%$a*na
*p/%*a+% $an !"ra# a#a r%nanna *p/%*a+%. Nan, a$ana %n6"*+% $an
'a/anan $%+"!a!*an /"' !a# an !"ra$a $%$a/a +a/ran !%/%ar%+ +"'%na $apa#
"nan;a %&a. Wa/apn $"%*%an, $"nan $%an+%+ $an p"n!a#an an ;"pa#
+"r#a #"pa#, 'a+%/ an $%$apa#*an !%a+ana +ana# !a%*.9,,10
BAB III
RINGKASAN
K/"/%#%a+%+ a#a !a# "p"$ "rpa*an p"na*%# an ;*p +"r%n
$%$"r%#a /"' &an%#a, #"r#aa +%a an#ara 20-70 #a'n. Ba# "p"$ na
$%!"$a*an "na$% 3 "n%+, a%# !a# */"+#"r/, !a# !%/%r!%n a#a !a# p%"n
;*/a# $an !a# p%"n '%#a.
Ba# */"+#"r/ "rpa*an an #"r+"r%n $%#"*an, $"nan *an$nan
*/"+#"r/ /"!%' $ar% 90. Ba# "p"$ $apa# $%#"*an $% $a/a *an$n "p"$
%# +"n$%r%, a#a $apa# a $%#"*an $%+a/ran-+a/ran "p"$, +"p"r#% $*#+
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+%+#%*+ a#a $*#+ */"$*+. S"*%#ar 80 pa+%"n $"nan !a# "p"$, !%a+ana
a+%#a#%+.
S"$an*an pa$a an +%#a#%*, *"/'an #aana !%a+a !"rpa n"r% $%
$a"ra' "p%a+#r%, *a$ran *anan a#a+ a#a pr"*r$%, $an */%* !%/%"r. "n"!a!
$ar% !a# "p"$ %n% !"/ $%*"#a'% +";ara pa+#%, #"#ap% $%p"r*%ra*an a$a 3 6a*#r
pr"$%+p+%+% #"rp"n#%n, a%#
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DAFTAR PUSTAKA
1. :"+ana :. Ba# p"$ $a/a B* Aar "na*%# Da/a J%/%$ 1. $%+%
I.Ja*ar#a Ba/a% "n"r!%# Fa*/#a+ K"$*#"ran Un%4"r+%#a+ In$n"+%a.
2009.@9 @81.
2. :!an#!%n S. M, ""r%*+aan 6%+%* $an M"n#a/, Ja*ar#a Fa*/#a+
*"$*#"ranUn%4"r%#a+ In$n"+%a, 18.
3. Brnn"r+$$ar#, K"p"ra&a#an"$%;a/ !"$a' / 2. Ja*ar#a.
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