Case Chirrosis Hepatis

8/17/2019 Case Chirrosis Hepatis

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Chirrosis Hepatis e.c

Chronic Hepatitis B

Case Report : dr. Irwin Sp.PD


2/28

IDENTITY • M r . T

Name • 5 ! . o

"#e

• S a p t a m a r # a $ % & $ ' ( S i n a r ) a ! a . T e * + , - a m ) e

"ddress • T r + c , D r i e r

-o) • D '

/ast Ed+cation • M a r r i e d

Marita* Stat+s • M o e s * e m

Re*i#ion • S + n d a n e s eEthnic

• - + n e 0 t h $ 1 "dmission

• R e n # a s d e n # , * o ,

Room


3/28

"namneseta,en on Th+rsda! -+ne %th $1

•

E n * a r # e d o 2 t h e

s t o m a c h s i n c e ' m o n t h ) e 2 o r e h o s p i t a * i 3 e dMain

Comp*ai

nt

• D ! s p n o e • N a + s e a • 4 e d e m i n ) o t h

e t r e m i t i e s"ddition

a*Comp*ai

nt


4/28

Pict+re o2 the patient


5/28

Histor! o2 Present Disease

Present condition o2 the patient started 6month a#o. 7hen he and his wi2e came toRS8D 9arawan# 2or ro+tine chec, +p 2or hisDM in Interna* Medicines c*inic.

That moment he admitted that his *e#s wasswo**en( he a*so said that his e!es and hiswho*e )od! was !e**ow in co*o+r. His stomachwas *itt*e en*ar#ed( )+t his wi2e tho+#ht that

was ;+st ordinar! )*oatin#.

"2ter eamination he was to*d that he #ot a*ier disease ndthat his HBs"# was positie.


6/28

"2ter that he 2e*t that his stomach wasen*ar#in# more and more. He admitted thathe eperienced a omit containin# )*ood

and his stoo* was containin# )*ood too( )+ton*! once.

He #ot the Hepatitis B treatment( +nti* itsc+red. He to*d that his )od! was )ein#

s,inn! )+t the stomach ,ept en*ar#in# and)oth *e#s and hands were swo**en.


7/28

Then he came a#ain to RS8D9arawan# and dia#nosed as ChirrosisHepatis.

He said that he has a paracintesis 'times 2rom ?e)r+ar!


8/28

"2ter stopped )ein# a sai*or( he)ecame a tr+c, drier +nti* now. Headmitted that he o2ten dr+n, mied

a*coho* with his 2riends.

He a*so *i,ed to dr+n, a traditiona*drin,s and sodas. "nd he was a

smo,er 2or a)o+t '$ !ears.


9/28

Histor

! o2Past

Disease

DM


10/28

Histor! o2 ?ami*! Disease

DM


11/28

Ha)its Histor!

•

D r + # s c o n s + m p t i o n

• B o d ! E c e r c i s e • T a t o o s

A

• " * c o h o * • S m o , i n # • C a r ) o n a t e d D r i n , s

• T r a d i t i o n a * D r i n , s

@


12/28

• Moderately ill

enera* appearance

• Compos mentis

Conscio+sness

enera* Conditionenera* Condition


13/28

IT"/ SINS

B*oodPress+r

e

•

$&%$mmH#

HeartRate

• &

mins

RespirationRate

•

&mins

Temperat+re

• '%($

C


14/28

Ph!sica* Eamination

• N o r m o c e p h a * i

Head

• " n e m i c c o n ; + n c t i a @ & @ ( •

I c t e r i c s c * e r a A & A

E!es

• / i p : c ! a n o s i s


15/28

Thora Eamination

- /+n# eamination

•

Inspection : S!mmetrica*( retraction


16/28

Thora Eamination


17/28

"BD4MIN"/ E"MIN"TI4N

• Inspection : Brown s,in(distended ( s,in a)norma*it!


18/28


19/28

Extremity Examination (2)

Pa*mar Er!tema


20/28

/"B4R"T4RY ?INDINMa!( th $1

Result Normal

H) 6($ 1 16 #K

/e+,oc!te $$ 5 1$ r)

Trom)oc!te 16.$$$ 15$ 05$r)

Ht 1 '6 0 K

DS 0' $ 10$ m#&d*

8re+m 1.5 1$ 05 m#&d*

Creatinine 1.$5 $(0 1(5 m#&d*


21/28

Result Normal

HBs"# @

S4T L 0$ +&/

SPT 16 L 0$ +&/

Protein tota* %(' %(5 (5 m#K

"*)+min 1( '(5 5($ m#K

*o)+*in 0(5 (% '(% m#K


22/28

RES8ME

" n a m

n e s eEn*ar#ement o2

the stomach

d!spnoe(na+sea

pain at +pperri#ht a)domen(oedemetremities

Hepatitis B( DM

Drin,in# a*coho*(traditiona*drin,s( andsodas.

P h

! s i c a *

E 5 a m i n a t i o n"nemic

Con;+n#tia @&@

Tenderness at

+pper ri#hta)domen

En*ar#ement o2sp*een inSch+Jners Point.

ShiJtin#d+**ness


23/28

DiJerentia* Dia#nosis

Chirrosis

Hepatis e.c"*coho* and DMt!pe

Chirrosis

Hepatis e.cChronicHepatitis B and

DM t!pe


24/28

7or,in# Dia#nosis

•Chirrosis Hepatis e.c Chronic

Hepatitis B•DM t!pe


25/28

S+##ested Eamination

• 8S ")domen

• T

•

E9• Thora Photo


26/28

Treatment

Medicamentosa

• I?D D5 dpm

• /asi $ amp• Spirono*acton '1

• "mino2+sin Hepar 11

• H+ma*o# '1% 8

• In;. Ce2triaon #r

• "*)+min $ K 1$$cc

Non-Medicamentosa

• N+tritiona* Therap!

• Parac!ntesis


27/28

Pro#nosis

• "d itam : D+)ia ad Bonam

• "d ?+n#tionam : D+)ia ad

Ma*am• "d Sanationam : D+)ia ad

Ma*am


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Documents

Case Chirrosis Hepatis