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1 Okt 2015

PR UJIAN

LINDAH SYAFAASTUTI/ 1102011141

1. MELENA

a. ETIOLOGI

1. Kelainan i e!"#$a%&!.

a. 'a(i!e! E!")a%&!

*ene(ita en%an $e+ate+e!i! +elena ,an% i!e-a-kan #ea$n,a a(i!e!

e!")a%&! tiak #e(na$ +en%el&$ (a!a n,e(i ata& #ei$ i e#i%a!t(&+. *aa

&+&+n,a !i)at #e(a(a$an ti+-&l !#"ntan an +a!i). Da(a$ ,an%

i+&nta$kan -e(a(na ke$ita+$ita+an an tiak +e+-ek& ka(ena !&a$

-e(a+#&( en%an a!a+ la+-&n%.

-. Ka(!in"+a E!")a%&!

Ka(!in"+a e!")a%&! !e(in% +e+-e(ikan kel&$an +elena a(i#aa

$e+ate+e!i!. Di!a+#in% +en%el&$ i!)a%ia -aan +en%&(&! an ane+i!

$an,a !e!ekali #ene(ita +&nta$ a(a$ an it&n tiak +a!i). *aa

#e+e(ik!aan en"!k"#i 3ela! te(li$at %+a-a(an ka(!in"+a ,an% $a+#i(

+en&t e!")a%&! an +&a$ -e(a(a$ ,an% te(letak i !e#e(ti%a -aa$

e!")a%&!.

. Sin("+a Mall"(, ei!!

Se-el&+ ti+-&l $e+ate+e!i! ia$&l&i +&nta$+&nta$ $e-at ,an% #aa

ak$i(n,a -a(& ti+-&l #e(a(a$an +i!aln,a #aa #e+in&+ alk"$"l ata&

#aa $a+il +&a. 6ia!an,a i!e-a-kan "le$ ka(ena te(lal& !e(in% +&nta$

+&nta$ $e-at an te(&! +ene(&!. 6ila #ene(ita +en%ala+i i!)a%ia

ke+&n%kinan i!e-a-kan "le$ ka(!in"+a e!")a%&!.

. E!")a%iti! an t&kak E!")a%&!.

E!")a%iti! -ila !a+#ai +eni+-&lkan #e(a(a$an le-i$ !e(in% -e(!i)at

inte(+itte+ ata& k("ni! an -ia!an,a (in%an !e$in%%a le-i$ !e(in% ti+-&l

+elena a(i#aa $e+ate+e!i!. T&kak i e!")a%&! 3a(an% !ekali

+en%aki-atkan #e(a(a$an 3ika i-anin%kan en%an t&kak la+-&n% an

&"en&+.

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2. Kelainan i La+-&n%

a. Ga!t(iti! E(i!"a He+"(a%ika

He+ate+e!i! -e(!i)at tiak +a!i) an ti+-&l !etela$ #ene(ita +in&+

"-at"-atan ,an% +en,e-a-kan i(ita!i la+-&n%. Se-el&+ +&nta$#ene(ita +en%el&$ n,e(i &l& $ati. *e(l& itan,akan 3&%a a#aka$ #ene(ita

!ean% ata& !e(in% +en%%&nakan "-at (e+atik 7NSAID 8 !te("i9 ata&ka$

!e(in% +in&+ alk"$"l ata& 3a+&3a+&an.

-. T&kak La+-&n%.

*ene(ita +en%ala+i i!#e#!i -e(a +&al +&nta$ n,e(i &l& $ati an

!e-el&+ $e+ate+e!i! ia$&l&i (a!a n,e(i ata& #ei$ i e#i%a!t(&+ ,an%

-e($&-&n%an en%an +akanan. Se!aat !e-el&+ ti+-&l $e+ate+e!i! ka(ena(a!a n,e(i an #ei$ i(a!akan !e+akin $e-at. Setela$ +&nta$ a(a$ (a!a

n,e(i an #ei$ -e(k&(an%. Si)at $e+ate+e!i! tiak -e%it& +a!i) an

+elena le-i$ "+inan a(i $e+ate+e!i!.

. Ka(!in"+a La+-&n%.

In!ien!i ka(!in"+a la+-&n% i ne%a(a kita te(%"l"n% !an%at 3a(an% an

#aa &+&+n,a atan% -e("-at !&a$ ala+ )a!e lan3&t an !e(in%+en%el&$ (a!a #ei$ n,e(i i ae(a$ &l& $ati !e(in% +en%el&$ +e(a!a

leka! ken,an% an -aan +en3ai le+a$. Le-i$ !e(in% +en%el&$ ka(ena

+elena.

. Ulk&! #e#tik&+

e. T&+"( la+-&n% 3inak an %ana!

). *ea$n,a #e+-&l&$ a(a$ ,an% !kle("tik T6: ie(tik&l&+ !i)ili!

3a(in%an #ank(ea! $ete("t("#ik $e(nia $iat&! e!"#$a%&! -ena a!in%

&lk&! &"en&+ t&kak !t(e!! ak&t.

;. *en,akit &!&! $al&!

a. T&+"( 3inak an %ana!

-. S,n("+e *e&t

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. Die(tik&l&+ Mekel

4. *en,akit k"l"n #("k!i+al

a. T&+"( 3inak an %ana!

-. Die(tik&l"!i!

. Ul!e(a!i an k"liti! %(an&l"+at"!a

. T&-e(k&l"!i!

e. Di!ent(i a+&-a

). Lainlain 7 Telan%iekta!i! Ane&(i!+a !i(!"i 9

5. Kelainan a(a$ > #"li!ite+ia e(a li+)"+a le&ke+ia ane+ia

#e(ni!i"!a $e+")ilia $i#"#("t("+-ine+ia +&lti#le +iel"+a #en,akit

:$(i!t+a! t("+-"!it"#enia #&(#&(a n"nt("+-"!it"#enia #&(#&(a an

lainlain.

?. *en,akit #e+-&l&$ a(a$

a. Telan%iekta!i! $e+"(a%ik $e(eite(

-. He+an%i"+a kae(n"!&+

@. *en,akit !i!te+ik > a+il"i"!i! !a(k"i"!i! #en,akit 3a(in%an ikat

&(e+ia an lainlain.

. *en,akit in)ek!i > DHF Le#t"!#i("!i!.

B. O-at"-at &l!e("%enik > !ali!ilat k"(tik"!te("i alk"$"l NSAID

7in"+eta!in )enil-&ta

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10. Ka)ein alk"$"l ll.

-. DIAGNOSA 6ANDING

Int(akti-ilita! ,ait& &lk&! ,an% +e+-anel ,an% -e(a(ti -a$a te(a#i

+eik tela$ %a%al +en%ata!i %e3ala %e3ala !ea(a aek&at. *ene(ita

a#at te(%an%%& ti&(n,a "le$ n,e(i ke$ilan%an akt& &nt&k -eke(3a!e(in% +e+e(l&kan #e(aatan i CS ata& $an,a tiak +a+#&

+en%ik&ti a(a #en%"-atan

*e(a(a$an )e!e! a#at #"!iti) akan a(a$ !a+a( ata& +&n%kin $ita+

an !e#e(ti te( 7+elena9. *e(a(a$an +a!!i) a#at +en%aki-atkan

$e+ate+e!i! 7+&nta$ a(a$9 +eni+-&lkan !,"k an +e+e(l&kan

t(an!)&!i a(a$ an #e+-ea$an a(&(at.

*e()"(a!i

O-!t(&k!i te(3ai #aa #int& kel&a( la+-&n% aki-at #e(aan%an an

ee+a

. *EMECIKSAAN *ENUN=ANG

*e+e(ik!aan )i!ik a#at +en&n3&kan aan,a n,e(i n,e(i tekan

e#i%a!t(ik ata& i!ten!i a-"+inal. 6i!in% &!&! +&n%kin tiak aa.

*e+e(ik!aan en%an -a(i&+ te($aa# !al&(an GI ata! a#at +en&n3&kan

aan,a &lk&!.

En"!k"#i GI ata! i%&nakan &nt&k +en%ienti)ika!i #e(&-a$an

in)la+a!i &lk&! an le!i. M&k"!a a#at !ea(a lan%!&n% ili$at an

-i"#!, ia#atkan.

Aan,a H. #,l"(i a#at itent&kan en%an -i"#!, an $i!t"l"%,

+elal&i k&lt&(.

. TATALAKSANA

1. *en%aa!an an #en%"-atan &+&+

*ene(ita $a(&! ii!ti(a$atkan +&tlak "-at"-at ,an%

+eni+-&lkan e)ek !eati) +"()in +e#e(iin an #a(ale$i

!e-aikn,a i$ina(kan.

*ene(ita i#&a!akan !ela+a #e(a(a$an +a!i$ -e(lan%!&n% an

-ila #e(a(a$an -e($enti a#at i-e(ikan +akanan ai(.

In)&! ai(an lan%!&n% i#a!an% an i-e(ilan la(&tan %a(a+

)i!i"l"%i! !ela+a -el&+ te(!eia a(a$. *en%aa!an te($aa# tekanan a(a$ nai ke!aa(an #ene(ita an

-ila #e(l& i#a!an% :'* +"nit"(.

*e+e(ik!aan kaa( $e+"%l"-in an $e+at"k(it #e(l& ilak&kan

&nt&k +en%ik&ti keaaan #e(a(a$an.

T(an!)&!i a(a$ i#e(l&kan &nt&k +en%%ati a(a$ ,an% $ilan% an

+e+#e(ta$ankan kaa( $e+"%l"-in 50@0 $a(%a n"(+al.

*e+-e(ian "-at"-atan $e+"!tatik !e#e(tiita+in K 4 10

+%/$a(i ka(-a!"k("+ 7A"na A:9 anta!ia an %"l"n%an H2

(e!e#t"( anta%"ni! 7!i+etiin ata& (anitiin9 -e(%&na &nt&k

+enan%%&lan%i #e(a(a$an.

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Dilak&kan kli!+a ata& lae+en en%an ai( -ia!a i!e(tai #e+-e(ian

anti-i"tika ,an% tiak i!e(a# "le$ &!&! !e-a%ai tinaakan

!te(ili!a!i &!&!. Tinakan ini ilak&kan &nt&k +ene%a$ te(3ain,a

#enin%katan #("&k!i a+"niak "le$ -akte(i &!&! an ini a#at

+eni+-&lkan en!e)al"#ati $e#atik.

2. *e+a!an%an #i#a na!" %a!t(ik

T&3&an #e+a!an%an #i#a na!" %a!t(ik aala$ &nt&k a!#i(a!i ai(an

la+-&n% laa%e 7k&+-a$ la+-&n%9 en%an ai( an #e+-e(ian

"-at"-atan. *e+-e(ian ai( #aa k&+-a$ la+-&n% akan

+en,e-a-kan a!"k"nt(ik!i l"kal !e$in%%a i$a(a#kan te(3ai

#en&(&nan ali(an a(a$ i +&k"!a la+-&n% en%an e+ikian

#e(a(a$an akan -e($enti. K&+-a$ la+-&n% ini akan ilak&kan

-e(&lan% kali +e+akai ai( !e-an,ak 100 150 +l !a+#ai ai(an

a!#i(a!i -e(a(na 3e(ni$ an -ila #e(l& tinakan ini a#at i&lan%

!etia# 12 3a+. *e+e(ik!aan en"!k"#i a#at !e%e(a ilak&kan

!etela$ ai(an a!#i(a!i la+-&n% !&a$ 3e(ni$.

;. *e+-e(ian #it(e!in 7a!"#(e!!in9

*it(e!in +e+#&n,ai e)ek a!"k"kt(ik!i #aa #e+-e(ian #it(e!in #e(

in)&! akan +en%aki-atkan k"nt(ik!i #e+-&l&$ a(a$ an

!#lanknik&! !e$in%%a +en&(&nkan tekanan ena #"(ta en%an

e+ikian i$a(a#kan #e(a(a$an a(i!e! a#at -e($enti. *e(l&

iin%at -a$a #it(e!in a#at +en(an%!an% "t"t #"l"! !e$in%%a a#at

te(3ai a!"k"nt(ik!i k"("ne( ka(ena it& $a(&! -e($ati$ati en%an

#e+akaian "-at te(!e-&t te(&ta+a #aa #ene(ita #en,akit 3ant&n%

i!ke+ik. Ka(ena it& #e(l& #e+e(ik!aan elekt("ka(i"%(a+ anana+ne!i! te($aa# ke+&n%kinan aan,a #en,akit 3ant&n%

k"("ne(/i!ke+ik.

4. *e+a!an%an -al"n S6 T&-e

Dilak&kan #e+a!an%an -al"n S6 t&-e &nt&k #ene(ita #e(a(a$an

aki-at #ea$n,a a(i!e!. Se-aikn,a #e+a!an%an S6 t&-e ilak&kan

!e!&a$ #ene(ita tenan% an k""#e(ati) !e$in%%a #ene(ita a#at

i-e(ita$& an i3ela!kan +akna #e+akaian alat te(!e-&t a(a

#e+a!an%ann,a an ke+&n%kinan ke(3a ik&tan ,an% a#at ti+-&l

#aa akt& an !ela+a #e+a!an%an.6e-e(a#a #eneliti +ena#atkan

$a!il ,an% -aik en%an #e+akaian S6 t&-e ini ala++enan%%&lan%i #e(a(a$an !al&(an +akan -a%ian ata! aki-at

#ea$n,a a(i!e! e!")a%&!. K"+#lika!i #e+a!an%an S6 t&-e ,an%

-e(at !e#e(ti la!e(a!i an (t&( e!")a%&! "-!t(&k!i 3alan na#a! tiak

#e(na$ i3&+#ai.

5. *e+akaian -a$an !kle("tik

6a$an !kle("tik !"i&+ +"(($&ate 5 !e-an,ak 5 +l ata&

!"t(e"l ; !e-an,ak ; +l en%an -ant&an )i-e(en"!k"# ,an%

)lek!i-el i!&ntikan i#e(+&kaan a(i!e! ke+&ian itekan en%an

-al"n S6 t&-e. Tinakan ini tiak +e+e(l&kan na(k"!e &+&+ ana#at i&lan% -e-e(a#a kali. :a(a #en%"-atan ini !&a$ +&lai

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#"#&le( an +e(akan !ala$ !at& #en%"-atan ,an% -a(& ala+

+enan%%&lan%i #e(a(a$an !al&(an +akan -a%ian ata! ,an%

i!e-a-kan #ea$n,a a(i!e! e!")a%&!.

?. Tinakan "#e(a!i

6ila &!a$a&!a$a #enan%%&lan%an #e(a(a$an iata! +en%ala+ike%a%alan an #e(a(a$an teta# -e(lan%!&n% +aka a#at

i#iki(kan tinakan "#e(a!i. Tinakan "#e(a!i ,an% -a!a

ilak&kan aala$ > li%a!i a(i!e! e!")a%&! t(an!ek!i e!")a%&!

#inta!an #"(t"kaal.

O#e(a!i e)ekti) ian3&(kan !etela$ ? +in%%& #e(a(a$an -e($enti

an )&n%!i $a(i +e+-aik.

2. GASTCITIS

a. ETIOLOGI

Men&(&t K&+a( :"t(an C"--in! 7200@9 Ga!t(iti! i!e-a-kan "le$ > *e+akaian NSAID ala+ "!i! -e!a(.

K"n!&+!i al"$"l -e(le-i$an.

6an,ak +e("k"k.

*e+-e(ian "-at ke+"te(a#i anti kanke(.

U(e+ia.

In)ek!i Si!te+ik.

St(e!! -e(at

I!ke+ia an S,"k

T(a&+a +ekani! 7int&-a!i na!"%at(ik9