Case - Ulkus Diabetikum Pro Amputasi

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    STATUS ILMU BEDAH

    RUMAH SAKIT ANGKATAN LAUT DR. MINTOHARJO

    BENDUNGAN HILIR, JAKARTA PUSAT

    Nama penyusun : Mo!ama" Sa#$%o &a%'

    NIM : ()(.*(.*+(

    Pem%m%n- : D$. A-nes Sp. B. K/ K0

    I. IDENTITAS PASIEN

    Nama : So1e!, Tn.

    Jen%s Ke1am%n : La2%31a2%

    Us%a : 45 #a!un

    A1ama# : Keman-an U#a$a RT (()6((7 Ja2a$#a Ba$a#

    Pen"%"%2am : SD

    Pe2e$8aan : Sa#pam

    S#a#us pe$n%2a!an : Men%2a!A-ama : Is1am

    Ruan- Pe$a9a#an : P. Sa1a9a#%

    Tan--a1 Masu2 : Se1asa, 746**6*

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    II. ANAMNESIS

    Anamnes%s "%1a2u2an sea$a a11oanamnes%s #e$!a"ap %s#$% pas%en "% $uan- 7

    an-sa1 P. Sa1a9a#% pa"a #an--a1 76*767(*.

    *. Ke1u!an u#ama

    Pas%en "a#an- 2a$ena 1u2a "% 2a2% 2anan se8a2 7 u1an SMRS.

    7. Ke1u!an #ama!an

    T%"a2 #e$"apa# 2e1u!an #ama!an.

    ). R%9aya# penya2%# se2a$an- RPS/

    Pas%en a9a1nya pas%en mem%1%2% 1u2a "% 8a$% #en-a! 2a2% 2anan se8a2 73) u1an

    SMRS, pas%en memu#us2an un#u2 meme$%2sa2annya 2e RSAL D$. M%n#o!a$"8o,

    peme$%2saan pe$#ama "%1a2u2an se2%#a$ u1an O2#oe$ 7(*, "%mana "%pu#us2an a!9a )

    8a$% pe$#ama 2a2% 2anan !a$us "%ampu#as% un#u2 mene-a! pen8a1a$an 1u2a. Pas%en

    2emu"%an men8a1an% ampu#as% ee$apa !a$% 2emu"%an "% 8a$% I, II "an III 2a2% 2anannya.

    Se#e1a! men8a1an% ampu#as%, pas%en menya"a$% a!9a 1u2a #e#ap men8a1a$ 2e

    a-%an 1a%n "a$% 2a2%nya #e$u#ama 8a$% yan- #e$s%sa, pen8a1a$an %#u #e$8a"% "a1am 9a2#u

    2u$an- 1e%! sa#u m%n--u pasa3ampu#as%. Semen8a2 "%1a2u2annya ampu#as%, pas%en

    me1a2u2an 2on#$o1 1u2a "% po1%21%n%2, !%n--a se2a$an- "%pu#us2an un#u2 "%$a9a#3%nap2an

    un#u2 pe$s%apan men8a1an% ampu#as% yan- 2e37.

    Pas%en #e$"%a-nos%s men"e$%#a "%ae#es me11%#us #%pe 7 se8a2 #a!un 7(*(. Pas%en

    mem%1%2% $%9aya# 1u2a pa"a 2a2% 2%$%nya pa"a saa# %n% yan- mem%1%2% 2a$a2#e$%s#%2 yan-

    !amp%$ sama "en-an apa yan- #e$8a"% saa# %n%, "%se$#a% penu$unan e$a# a"an yan-

    "$as#%s, yan- "%ama#% o1e! %s#$%nya. Saa# meme$%2sa2an 2e RSAL pa"a saa# %#u, -u1a "a$a!

    pas%en menun8u22an )( m-6"L. Pas%en pa"a saa# %#u, 8u-a "%pu#us2an un#u2 men8a1an%

    ampu#as% pa"a 2a2% 2%$%nya 2a$ena 1u2a yan- #%"a2 2un8un- mema%2.

    R%9aya# !%pe$#ens% "%san-2a1.

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    4. R%9aya# penya2%# "a!u1u RPD/

    Pas%en #e$"%a-nos%s "%ae#es me11%#us #%pe 7 pa"a #a!un 7(*(. Ha1 %n% "%"asa$%

    "%an#a$anya o1e! 1u2a pa"a 2a2% 2%$%nya yan- sema2%n memesa$ "an #%"a2 2un8un- semu!,

    penu$unan e$a# a"an yan- #e$ama#% u2up "$as#%s "an !as%1 peme$%2saan -u1a "a$a! pa"a

    9a2#u #e$seu# yan- menun8u22an an-2a )( m-6"L

    Pas%en mem%1%2% $%9aya# 1u2a "en-an 2a$a2#e$%s#%2 yan- sama pa"a 2a2% 2%$%nya pa"a

    #a!un 7(*(, a2%a#nya pas%en men8a1an% ampu#as% pa"a 2a2% 2%$%nya #e$seu#.

    . R%9aya# penya2%# 2e1ua$-a RPK/

    D%a2u% a!9a sepupu 8au! pas%en men"e$%#a "%ae#es me11%#us sama sepe$#% pas%en. D%

    2e1ua$-a %n#% pas%en, #%"a2 a"a yan- mem%1%2% penya2%# "en-an 2a$a2#e$%s#%2 sama sepe$#%

    pas%en.

    ;. R%9aya# a1e$-% RA/

    Pas%en "%a2u% %s#$%nya mem%1%2% 2eme$a!an pa"a 2u1%#nya saa# su!u e$ua! "en-an

    epa# "an 8%2a pas%en men-onsums% oa# #e$#en#u. T%"a2 "%2e#a!u% -o1on-an a#au nama oa#

    %n%.

    5. R%9aya# 2e%asaan RB/

    Pas%en "%a2u% men-onsums% 2op% se2%#a$ 7

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    D%a2u% pas%en #%n--a1 "%1%n-2un-an yan- e$s%!. D%$uma!nya, pas%en #%n--a1 e$sama

    4 o$an- 1a%nnya. 0en#%1as% "an pena!ayaan "%a2u% u2up.

    >. R%9aya# sos%a13e2nonom% RE/

    D%a2u% o1e! %s#$%nya a!9a 2e!%"upan sos%a1 e2onom% 2e1ua$-anya e$2eu2upan.

    Kea"aan 2euan-an pas%en "%"u2un- o1e! sa#u ana2nya yan- #e1a! e2e$8a "an o1e! pas%en

    sen"%$%. Pas%en e2e$8a sea-a% sa#pam "an pe$na! e2e$8a sea-a% o8e2

    III. PEMERIKSAAN FISIK

    Kea"aan u mum

    3 Kesa"a$an : Compos mentis

    3 Kesan sa2%# : Tampa2 sa2%# se"an-

    3 Kesan -%'% : G%'% u2up

    T an"a3#an"a ?%#a1 :

    3 TD : *7(6+( mmH-

    3 N : +4

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    H%"un- : De=o$m%#as 3/,

    Mu1u# : s%anos%s 3/, %%$ "an mu2osa mu1u# #%"a2 2e$%n-

    LEHER

    Inspe2s% : KGB "an 2e1en8a$ #%$o%" #%"a2 #ampa2 memesa$.

    THORAKS

    Inspe2s% : T%"a2 #ampa2 e=1o$esens% yan- e$ma2na, -e$a2 pe$na=asan s%me#$%s, #%"a2

    #ampa2 pe$-e$a2an na=as yan- #e$#%n--a1, #u1an- %-a #%"a2 #e$1a1u ?e$#%2a1 maupun

    !o$%'on#a1, $e#$a2s% o#o#3o#o# pe$napasan 3/.

    Aus2u1#as% :

    3 Jan#un- : Buny% 8an#un- I II $e-u1a$, mu$mu$ 3/ -a11op 3/.

    3 Pa$u : Sua$a napas ?es%2u1e$ C6C/, 9!ee'%n- 363/, Ron2% 363/.

    ABDOMEN

    Inspe2s% : T%"a2 #ampa2 e=1o$esens% yan- e$ma2na.

    EKSTREMITAS

    Inspe2s% : S%me#$%s, #%"a2 #ampa2 e=1o$esens% yan- e$ma2na, 2a2% 2%$% #e$3ampu#as%

    Pa1pas% : A2$a1 manus #e$aa !an-a#.

    Status loalis

    S#a#us 1o2a1%s pa"a pe"%s 2anan

    Inspe2s%: "%-%#% I, II, III pos# ampu#as%, 8a$%n-an ne2$o#%2 "%-%#% I0 "an 0 "an a-%an

    1a#e$a1 2a2% 2anan.

    I!. PEMERIKSAAN PEN"N#ANG

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    Pe$erisaan la%oratoriu$ (&'//)

    H : +.5 -6"LNo$ma1: *73*; -6"L/

    H# : 7; ?o1 No$ma1 : )534) ?o1 /

    Leu2os%# : *.)((6uLNo$ma1 : .(((3*(.(((6uL/ E$%#$os%# : ).* 8u#a 6uLNo$ma1: 4.3. 8u#a6uL/

    Hema#o2$%# : 7+ No$ma1 : 4734+/

    T$omos%# : 47.(((6mm)No$ma1 :7((.(((3((.(((6mm)/

    B1ee"%n- #%me : 7 men%# N: *3)/

    @1o##%n- #%me : *7 men%# N: 3*/

    G1u2osa "a$a! se9a2#u: 74 m-6"LN: F 7(( m-6"L/

    U$eum : )+ m-6"L N: *534) m-6"L/

    K$ea#%n%n : *.( m-6"L N: (.3*. m-6"L/

    !. RINGKASAN

    Pas%en "a#an- "en-an 1u2a "% 2a2% 2anannya 7 u1an SMRS. Pas%en #e$"%a-nos%s

    "en-an DM #%pe 7 se8a2 #a!un 7(*(, men-a2%a#2an 1u2a pa"a 2a2% 2%$%nya yan-

    menyea2an 2ema#%an 8a$%n-an yan- 2emu"%an "%ampu#as%. 7 u1an SMRS mu1a% #e$"apa#

    1u2a pa"a 2a2% 2anan pas%en menyea2an 2ema#%an 8a$%n-an pa"a "%-%#% I, II "an III 2a2%

    2anan pas%en yan- 2emu"%an "%ampu#as%. Ka$ena 1u2a men8a1a$, 2e 8a$% yan- #e$s%sa "an

    a-%an 1a#e$a1 2a2% 2anan pas%en, ma2a "%pu#us2an 2ema1% un#u2 men8a1an% ampu#as%.

    Pas%en mem%1%2% 2e%asaan 2onsums% 2op% 7

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    Pa"a pas%en %n%, masa1a! "%#e-a22an e$"asa$2an !as%1 anamnes%s "an peme$%2saan

    =%s%2 1o2a1%s "%"u2un- "en-an peme$%2saan 1ao$a#o$%um. Pa"a anamnes%s "%#emu2an a!9a

    pas%en #e1a! #e$"%a-nos%s "en-an DM #%pe 7 pa"a #a!un 7(*(, yan- menyea2an 1u2a pa"a

    2a2% 2%$%nya "en-an 2a$a2#e$%s#%2 yan- m%$%p "en-an 1u2a yan- "%a1am% saa# %n%, sepe$#% #%"a2

    2un8un- semu!, #e$us men8a1a$ "an #%"a2 nye$%. Pas%en men-a2u 1u2a 2a1% %n% m%$%p "en-an

    1u2a see1umnya 2a1% %n% pa"a 2a2% 2anannya, #e$8a"% se8a2 7 u1an yan- 1a1u #%"a2 2un8un-

    semu! men-a2%a#2an ) 8a$% pe$#ama !a$us "%ampu#as%, #e#ap% 1u2a #e$us men8a1a$ 2e 8a$%

    yan- #e$s%sa "an 8u-a a-%an 1a#e$a1 2a2% pas%en, #e$1%!a# "a1am 9a2#u sa#u m%n--u.

    Pe2e$8aan pas%en sea-a% sa#pam, mun-2%n e$pen-a$u! 1an-sun- 2epa"a munu1nya

    1u2a, 2emun-2%nan "%2a$ena2an 1ama e$8a1an "an e$"%$% un#u2 me1a2u2an pa#$o1% un#u2

    men8a-a 2eamanan men-a2%a#2an 1u2a 2e%1 yan- sema2%n 1ama sema2%n memesa$ a2%a#

    %$%#as% #e$us mene$us pa"a 2u1%# 2a2% "an #%"a2 #e$oa#% a2%a# 2e#%a"aan nye$%, se!%n--a pas%en

    e$oa# saa# 1u2a su"a! 1uas "an 1ama. Pas%en 8u-a mem%1%2% -aya !%"up yan- $e1a#%= #%"a2

    se!a# yan- 2emun-2%nan e$2on#$%us% #e$!a"ap 2ea"aan 2ese!a#an umum "an mun-2%n

    sea$a 1an-sun- a#aupun #%"a2 1an-sun- menyea2an #%mu1nya 2ea"aan DM.

    Masa1a! anem%a pa"a pas%en %n% "%#e-a22an "a$% !as%1 anamnes%s "an peme$%2saan

    1ao$a#o$%um. Pas%en men-a#a2an a!9a "%$%nya me$asa 1emas. Pa"a peme$%2saan

    1ao$a#o$%um "%"apa#2an a!9a 2a"a$ !emo-1o%n "a$a! pas%en e$a"a pa"a n%1a% +.5 -6"L

    "an n%1a% e$%#$os%# yan- menu$un. Ha1 %n% 2emun-2%nan "%sea2an o1e! a"anya pe$"a$a!an

    a2#%= yan- #e$8a"% pa"a "ae$a! 1u2a pas%en. Pe$"a$a!an #e$seu# 2emun-2%nan 2e%1 #e#ap%

    e$an-su$3an-su$ men-a2%a#2an pemu$u2an 2ea"aan umum pas%en yan- -$a"ua1.

    Tan"a3#an"a mu1a% #e$8a"%nya %n=e2s% pa"a pas%en "%1%!a# "a$% a!9a pas%en me$asa2an

    nye$% pa"a "ae$a! 1u2a "an "ae$a! e2as ampu#as% yan- 1a1u. Se1a%n %#u, "%"apa#2an 2a"a$

    1eu2os%# yan- men%n-2a# yan- menun8u22an 2emun-2%nan a"anya %n=e2s%, In=e2s% %n%

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    2emun-2%nan #e$8a"% a2%a# e2sposu$e 1u2a 2epa"a "un%a 1ua$ a2%a# pema1u#an yan- #%"a2

    a"e2ua#.

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    !III. PENATA*AKSANAAN

    Pena#a1a2sanaan yan- "%1a2u2an pa"a pas%en %n% a"a1a! ampu#as% e1o9 2nee pa"a

    #an--a1 756**67(*. Ha1 %n% "%1a2u2an a#as pe$#%man-an 1u2a yan- #%"a2 2un8un- semu!,

    #e$us men8a1a$ "an #e$8a"%nya -an-$en pa"a 2a2% 2anan pas%en.

    Pre-oerati (&'/ &/)

    Pas%en #ampa2 sa2%# se"an- "an men-e1u! 1emas "%1a2u2an ose$?as% 2ea"aan umum.

    Ka"a$ ! pas%en e$a"a "%a9a! *( -6"L se!%n--a "%1a2u2an #$ans=us% [email protected] (( 2epa"a

    pas%en, se1a%n %#u "%e$%2an 8u-a e=#$%a

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    A" ?%#am : onam

    A" sana#%onam : "u%a a" ma1am

    A" =un#%onam : ma1am

    0. F1**12 "P

    Pasa ope$as%, pas%en men-e1u!2an nye$% "% "ae$a! e2as ope$as% yan- e$1an8u#

    !%n--a !a$% 2e3 pasa ope$as%. Nye$% yan- "%$asa2an me$upa2an nye$% $%n-an "en-an s2a1a

    nye$% ).

    Tan"a3#an"a ?%#a1 pas%en se8a2 e$a"a "% [email protected] !%n--a !a$%3!a$% se1an8unya "%n%1a%

    s#a%1. A"apun 2a"a$ -u1a "a$a! pas%en e$=u2#uas% "en-an $%n%an s:

    756**: GDS +7m-6"L

    7+6**: GDS *)+ m-6"L

    7>6**: GDS *+7 m-6"L

    *6*7: GDS 5 m-6"L

    76*7: GDS ;( m-6"L 3333 pe-!en#%an oa# an#% "%ae#%2

    H%n--a !a$% 2e3 pas%en mas%! men-a1am% anem%a "en-an 2a"a$ H yan- $e1a#%= men%n-2a#

    *(.+ -6"L/. H pas%en sempa# menapa% n%1a% *).+ -6"L sa#u !a$% pasa ope$as%. Ka"a$

    1eu2os%# pas%en #e$us na%2 menapa% n%1a% *>. )(( 6uL sa#u !a$% pasa ope$as%. Pa"a !a$% 2e3

    1eu2os%# menapa% n%1a% 7>.((6u1. Pas%en 8u-a men-a1am% !%poa1um%nem%a se#e1a!

    "%1a2u2an #es "a$a! pa"a !a$% 2e3 7.( -6"L/.

    TIN#A"AN P"STAKA

    Deinisi

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    U12us "%ae#%2um a"a1a! sa1a! sa#u en#u2 2omp1%2as% 2$on%2 D%ae#es me11%#us

    e$upa 1u2a #e$u2a pa"a pe$mu2aan 2u1%# yan- "apa# "%se$#a% a"anya 2ema#%an 8a$%n-an

    se#empa#.

    U12us "%ae#%2um me$upa2an 1u2a #e$u2a pa"a pe$mu2aan 2u1%# 2a$ena a"anya

    2omp1%2as% ma2$oan-%opa#% se!%n--a #e$8a"% ?as2u1e$ %nsus%=%ens% "an neu$opa#%, yan-

    1e%! 1an8u# #e$"apa# 1u2a pa"a pen"e$%#a yan- se$%n- #%"a2 "%$asa2an, "an "apa#

    e$2eman- men8a"% %n=e2s% "%sea2an o1e! a2#e$% ae$o maupun anae$o.

    Ei3e$iolo4i

    P$e?a1ens% pen"e$%#a u12us "%ae#%2um "% In"ones%a seesa$ * "a$% pen"e$%#a

    Dm. "% [email protected], pa"a #a!un 7(() masa1a! 2a2% "%ae#es mas%! me$upa2an masa1a!

    esa$. Sea-%an esa$ pe$a9a#an DM se1a1u #e$2a%# "en-an u12us "%ae#%2um. An-2a

    2ema#%an "an an-2a ampu#as% mas%! #%n--%,mas%n-3mas%n- seesa$ )7, "an 7),.

    Nas% pen"e$%#a DM pas2a ampu#as% mas%! san-a# u$u2, seanya2 *4,) a2an

    men%n--a1 "a1am se#a!un pas2a ampu#as% "an seanya2 )5 a2an men%n--a1 ) #a!un pasa

    ampu#as%.

    Etiolo4i 3an Fator Resio ulus 3ia%etiu$

    Bee$apa e#%o1o-% yan- menyea2an u12us "%ae#%2um me1%pu#% neu$opa#%, penya2%#

    a$#e$%a1,#e2anan "an "e=o$m%#as 2a2%. &a2#o$ $%s%2o #e$8a"% u12us "%ae#%2um pa"a pen"e$%#a

    D%ae#es me11%#us menu$u# L%ps2y "en-an mo"%=%2as% "%2u#%p o1e! R%yan#o "22.#e$"%$% a#as :

    a. &a2#o$3=a2#o$ $%s%2o yan- #%"a2 "apa# "%ua! :

    Umu$ ;( #a!un.

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    Lama DM *( #a!un.

    . &a2#o$3&a2#o$ R%s%2o yan- "apa# "%ua! : #e$masu2 2e%asaan "an -aya !%"up/

    Neu$opa#% senso$%2, mo#o$%2, pe$%=e$/.

    Oes%#as.

    H%pe$#ens%.

    G1%2o1sas% Hemo-1o%n HA*@/ #%"a2 #e$2on#$o1.

    Ka"a$ -1u2osa "a$a! #%"a2 #e$2on#$o1.

    Insus%=%ens% 0as2u1e$ 2a$ena a"anya A#e$os21e$os%s yan- "%sea2an :

    Ko1es#e$o1 To#a1 #%"a2 #e$2on#$o1.

    Ko1es#e$o1 HDL #%"a2 #e$2on#$o1.

    T$%-1%se$%"a #%"a2 #e$2on#$o1.

    Ke%asaan me$o2o2.

    Ke#%"a2pa#u!an D%e# DM.

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    Pato4enesis

    G$ *. Ba-an pa#o-enes%s u12us "%ae#%2um

    Sa1a! sa#u a2%a# 2omp1%2as% 2$on%2 a#au 8an-2a pan8an- D%ae#es me11%#us a"a1a!

    u12us "%ae#%2um. U12us "%ae#%2um "%sea2an a"anya #%-a =a2#o$ yan- se$%n- "%seu# T$%as

    ya%#u : Is2em%2, Neu$opa#%, "an In=e2s%

    Pa"a pen"e$%#a DM apa%1a 2a"a$ -1u2osa "a$a! #%"a2 #e$2en"a1% a2an #e$8a"%

    2omp1%2as% 2$on%2 ya%#u neu$opa#%, men%mu12an pe$ua!an 8a$%n-an sya$a= 2a$ena a"anya

    pen%munan so$%#o1 "an =$u2#osa se!%n--a men-a2%a#2an a2son men-!%1an-, penu$unan

    2eepa#an %n"u2s%, pa$as#es%a, menu$unnya $e=1e2 o#o#, a#$o=% o#o#, 2e$%n-a# e$1e%!an,

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    2u1%# 2e$%n- "an !%1an- $asa, apa%1a "%ae#%s% #%"a2 !a#%3!a#% "apa# #e$8a"% #$auma yan-

    a2an men8a"% u12us "%ae#%2um

    Is2em%2 me$upa2an sua#u 2ea"aan yan- "%sea2an o1e! 2a$ena 2e2u$an-an "a$a!

    "a1am 8a$%n-an, se!%n--a 8a$%n-an 2e2u$an-an o2s%-en. Ha1 %n% "%sea2an a"anya p$oses

    ma2$oan-%opa#% pa"a pemu1u! "a$a! se!%n--a s%$2u1as% 8a$%n-an menu$un yan- "%#an"a%

    o1e! !%1an- a#au e$2u$an-nya "enyu# na"% pa"a a$#e$% "o$sa1%s pe"%s, #%%a1%s "an

    pop1%#ea, 2a2% men8a"% a#$o=%, "%n-%n "an 2u2u menea1. Ke1a%nan se1an8u#nya #e$8a"%

    ne2$os%s 8a$%n-an se!%n--a #%mu1 u12us yan- %asanya "%mu1a% "a$% u8un- 2a2% a#au #un-2a%.

    A#e$os21e$os%s me$upa2an seua! 2on"%s% "%mana a$#e$% menea1 "an menyemp%#

    2a$ena penumpu2an 1ema2 pa"a a-%an "a1am pemu1u! "a$a!. Menea1nya a$#e$% "% 2a2%

    "apa# mempen-a$u!% o#o#3o#o# 2a2% 2a$ena e$2u$an-nya sup1a% "a$a!, se!%n--a

    men-a2%a#2an 2esemu#an, $asa #%"a2 nyaman, "an "a1am 8an-2a 9a2#u 1ama "apa#

    men-a2%a#2an 2ema#%an 8a$%n-an yan- a2an e$2eman- men8a"% u12us "%ae#%2umP$oses

    an-%opa#% pa"a pen"e$%#a D%ae#es me11%#us e$upa penyemp%#an "an penyuma#an pemu1u!

    "a$a! pe$%=e$, se$%n- #e$8a"% pa"a #un-2a% a9a! #e$u#ama 2a2%, a2%a# pe$=us% 8a$%n-an

    a-%an "%s#a1 "a$% #un-2a% men8a"% e$2u$an- 2emu"%an #%mu1 u12us "%ae#%2um.

    Pa"a pen"e$%#a DM yan- #%"a2 #e$2en"a1% a2an menyea2an penea1an #un%2a

    %n#%ma !%pe$p1as%a mem$am asa1%s a$#e$%/ pa"a pemu1u! "a$a! esa$ "an pemu1u!

    2ap%1e$ a!2an "apa# #e$8a"% 2eoo$an a1um%n 2e1ua$ 2ap%1e$ se!%n--a men--an--u

    "%s#$%us% "a$a! 2e 8a$%n-an "an #%mu1 ne2$os%s 8a$%n-an yan- men-a2%a#2an u12us

    "%ae#%2um

    E$%#$os%# pa"a pen"e$%#a DM yan- #%"a2 #e$2en"a1% a2an men%n-2a#2an HA*@

    yan- menyea2an "e=o$ma%1%#as e$%#$os%# "an pe1epasan o2s%-en "% 8a$%n-an o1e! e$%#$os%#

    #e$-an--u, se!%n--a #e$8a"% penyuma#an yan- men--an-u s%$2u1as% 8a$%n-an "an

    2e2u$an-an o2s%-en men-a2%a#2an

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    2ema#%an 8a$%n-an yan- se1an8u#nya #%mu1 u12us "%ae#%2um.

    Pen%n-2a#an 2a"a$ =%$%no-en "an e$#ama!nya $ea2#%?%#as #$omos%# menyea2an

    #%n--%nya a-$e-as% se1 "a$a! me$a! se!%n--a s%$2u1as% "a$a! men8a"% 1ama# "an

    memu"a!2an #e$en#u2nya #$omos%# pa"a "%n"%n- pemu1u! "a$a! yan- a2an

    men--an--u s%$2u1as% "a$a!

    Pen"e$%#a D%ae#es me11%#us %asanya 2a"a$ 2o1es#e$o1 #o#a1, LDL, #$%-1%se$%"a

    p1asma #%n--%. Bu$u2nya s%$2u1as% 2e sea-%an esa$ 8a$%n-an a2an menyea2an

    !%po2s%a "an e"e$a 8a$%n-an, me$an-san- $ea2s% pe$a"an-an yan- a2an me$an-san-

    #e$8a"%nya a#e$os21e$os%s.

    Pe$ua!an %n=1amas% pa"a pemu1u! "a$a!, a2an #e$8a"% penumpu2an 1ema2 pa"a

    1umen pemu1u! "a$a!, 2onsen#$as% HDLsea-a% peme$s%! p1a2 %asanya $en"a!.

    A"anya =a#o$ $%s%2o1a%n ya%#u !%pe$#ens%a2anmen%n-2a#2an 2e$en#anan #e$!a"ap

    a#!e$os1e$os%s.2onse2uens% a"anya a#!$os21e$os%s ya%#u s%$2u1as% 8a$%n-an menu$un

    !%n--a 2a2% men8a"% a#$o=%,"%n-%n "an 2u2u menea1. Ke1a%nan se1an8u#nya #e$8a"%

    ne2$os%s 8a$%n-an se!%n--a #%mu1 u12us yan- %asanya "%mu1a% "a$% u8un- 2a2% a#au #un-2a%.

    Pa"a pen"e$%#a DM apa%1a 2a"a$ -1u2osa "a$a! #%"a2 #e$2en"a1% menyea2an

    ano$ma1%#as 1e2os%# se!%n--a =un-s% 2!emo#o2s%s "% 1o2as% $a"an- #e$-an--u, "em%2%an

    pu1a =un-s% =a-os%#os%s "an a2#e$%s%" menu$un se!%n--a %1a a"a %n=e2s% m%2$oo$-an%sme

    su2a$ un#u2 "%musna!2an o1e! s%s#em p!1a-os%#os%s3a2#e$%s%" %n#$a se11u1e$.

    Pa"a pen"e$%#a u12us "%ae#%2um, ( a2an men-a1am% %n=e2s% a2%a# a"anya

    -1u2osa "a$a! yan- #%n--%, yan- me$upa2an me"%a pe$#umu!an a2#e$%

    yan- suu$. Ba2#e$% penyea %n=e2s% pa"a u12us "%ae#%2um ya%#u 2uman

    ae$o%2 S#ap!y1o2o2us a#au S#$ep#o2o2us se$#a 2uman anae$o ya%#u

    @1os#$%"%um pe$=$%n-ens, @1os#$%"%um no?y, "an @1os#$%"%um sep#%2um.

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    Tan3a 3an 4e5ala

    Tan"a "an -e8a1a u12us "%ae#%2um a"a1a! :

    a. Se$%n- 2esemu#an

    . Nye$% 2a2% saa# %s#%$a!a#

    . Sensa$% $asa e$2u$an-

    ". Ke$usa2an 8a$%n-an ne2$os%s/

    e. Penu$unan "enyu# na"% a$#e$% "o$sa1%s pe"%s,#%%a1%s,"an pop1%#ea1

    =. Ka2% men8a"% a#$o=%, "%n-%n 2u2u mene1

    -. Ku1%# 2e$%n-

    Klasiiasi

    G$ 7. K1as%=%2as% a-ne$

    K1as%=%2as% U12us "%ae#%2um pa"a pen"e$%#a D%ae#es me11%#us menu$u# a-ne$,

    #e$"%$% "a$% ; #%n-2a#an :

    ( T%"a2 a"a 1u2a #e$u2a, 2u1%# u#u!.

    * U12us Supe$=%s%a1%s, #e$a#as pa"a 2u1%#.

    16

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    7 U12us 1e%! "a1am se$%n- "%2a%#2an "en-an %n=1amas% 8a$%n-an.

    ) U12us "a1am yan- me1%a#2an #u1an-, sen"% "an =o$mas% ases.

    4 U12us "en-an 2ema#%an 8a$%n-an #uu! #e$1o2a1%s%$ sepe$#% pa"a %u

    8a$% 2a2%, a-%an "epan 2a2% a#au #um%#.

    U12us "en-an 2ema#%an 8a$%n-an #uu! pa"a se1u$u! 2a2%.

    Se"an-2an 21as%=%2as% un#u2 2e"a1aman 1u2a "an 1uasnya "ae$a! %s2em%2 menu$u# B$o"s2y:

    Be$"asa$2an 2e"a1aman 1u2a6 u1se$as%

    o ( : P$e "an pos# u1se$as%

    o * : 1u2a supe$=%s%a1 yan- menapa% ep%"e$m%s a#au "e$m%s a#au 2e"uanya, #ap%

    e1um menemus #en"on, 2apsu1 sen"% a#au u1an-.

    o 7 : 1u2a mememus #en"on a#au #u1an- #e#ap% e1um menapa%

    #u1an- a#au sen"%

    o ) : #u1an- menemus #u1an- a#au sen"%

    Be$"asa$2an 1uas "ae$a! %s2em%a

    o A : Tanpa %s2em%a

    o B : %s2em%a #anpa -an-$ene

    o @ : pa$#%a1 -an-$ene

    o D : @omp1e#e =oo# -an-$ene

    Pe$erisaan

    Apa%1a 2%#a menemu2an pas%en yan- "%u$%-a% a#au meman- mempunya%

    u12us "%ae#%2um,a"a ee$apa 1an-2a! yan- !a$us "%1a2u2an un#u2

    menen#u2an s#a#us 1u2a, ya%#u:

    Pen4a5ian lua:

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    a. Ten#u2an 1o2as% "an 1e#a2 1u2a

    Ten#u2an 1e#a2 2ee$a"aan 1u2a e$a"a "%a-%an #uu! mana

    !a1 %n% "apa# e$-una sea-a% %n"%a#o$ #e$!a"ap

    2emun-2%nan penyea #e$8a"%nya 1u2a, se!%n--a "apa#

    mem%n%ma1%s%$ 2e8a"%an #e$u1an- "en-an men-!%1an-2an

    penyeanya

    . Ten#u2an s#a"%um 1u2a

    Ten#u2an s#a"%um 1u2a e$"asa$2an 21as%=%2as% s#a"%um u12us

    "%ae#%2um "a$% 9a-ne$, e$"asa$2an 2e"a1aman "a$%

    1u2anya 8u-a #%n-2a# 2epa$a!an %s2em%a "a$% u12us

    . a$na pa"a "asa$ 1u2a

    Apa%1a 9a$na pa"a "asa$ 1u2a a"a1a! me$a! , ma2a 1u2a

    e$s%! "an anya2 ?as2u1a$%sas%nya. J%2a e$9a$na 2un%n-

    ma2a "apa# "%a$#%2an a!9a 8a$%n-an su"a! #e$%n=e2s%. J%2a

    e$9a$na !%#am ma2a 8a$%n-an su"a! ne2$os%s "an

    a?as2u1a$%sas%

    ". Ben#u2 "an u2u$an 1u2a

    Ka8% u2u$an 1u2a, "a$% pan8an- ,1ea$, "an 2e"a1aman 1u2a.

    e. S#a#us ?as2u1e$

    %. Su8e#%?e : apa2a! pas%en me$asa nye$% #e$!a"ap

    1u2anya

    %%. O8e#%?e : pse$?as% 9a$na 2u1%# apa2a! pua# a#au

    s%anos%s pa"a a-%an "%s#a1 1u2a

    %%%. Pa1pas% :

    *. Apa2a! a"a pe$ua!an pa"a su!u u8un- 2a2%

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    men8a"% 1e%! "%n-%n/

    7. Pa1pas% #e2anan na"% , pa"a a-%an "%s#a1 1u2a

    #e$apa a#au #%"a2

    Anle 6ra78ial In3es (A6I)

    An21e B$a!%a1 In"e< a"a1a! #es s2$%n%n- ?asu1a$ non %n?as%?e un#u2

    men-%"en#%=%2as% pemesa$an pemu1u! "a$a! , pe$%=e$ ?asu1a$

    "%sease "en-an a$a meman"%n-2an #e2anan "a$a! sys#o1% "% an21e

    "en-an #e2anan "a$a! s%s#o1%2 "% "ae$a! $a2%a1 "%mana "apa#

    "%pe$2%$a2an #e2anan "a$a! s%s#o1%2 sen#$a1nya. ABI "%u2u$ "en-an

    men--una2an a1a# ya%#u on#%nuous 9a?e "opp1e$, seua!

    sp!y-momanome#e$, "an seua! p$essu$e u==s un#u2 men-u2u$

    #e2anan s%s#o1%2 "% $a!%a1 "an an21e. ABI mempunya% sens%#%?%#as

    "an spes%=%s%#as yan- #%n--% "a1am men"%a-nos%s 1o9e$ e

    men-%n"%2as%2an a"anya 2e1a%an 1o9e$ e

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    menen#u2an p$oses #e$ap% 2omp$es%, a#au "e$%"emen# 1u2a.

    3 Un#u2 menen#u2an po#ens% penyemu!an 1u2a.

    KONTRAINDIKASI

    3 Nye$% yan- e$a# pa"a 2a2%

    3 A"anya "eep ?e%n #!$omos%s

    3 Nye$% yan- e$a# yan- "%!uun-2an "en-an 1u2a pa"a e2s#$em%#as

    a9a!

    KETERBATASAN ABI

    3 ABI a"a1a! #es %n"%$e2 un#u2 men-e#a!u% 1o2as% ana#om% seua!

    o21us% a#au s#enos%s. Lo2as% pas#% "a$% o21us% a#au s#enos%s #%"a2 "apa#

    "%2e#a!u% !anya "a$% ABI sa8a.

    PEMERIKSAAN ABI

    @a$a peme$%2saan ABI a"a1a! sea-a% e$%2u# :

    Ba$%n-2an pas%en 2u$an- 1e%! se1ama 7( men%#.

    Pas#%2an a$ea 2a2% #%"a2 a"a suma#an a#au !ama#an "a$% pa2a%an

    a#aupun pos%s%.

    Tu#up a$ea 1u2a "en-an 1ap%san me1%n"un-% u== yan- mene2an.

    Tempa#2an u== "% a#as an21e.

    Dopp1e$ p$oe 1e#a22an "% "o$sa1%s pe"%s "an an#e$%o$ #%%a1 pu1se

    "en-an 2one2#%n- -e1/. A$a! p$oe Dopp1e$ 4

    (

    Te2an u== !%n--a uny% pu1se men-!%1an-

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    Te2an u== pe$1a!an un#u2 menu$un2an #e2anan sampa% #e$"en-a$

    uny% pu1se 1a-%. Po%n# %n% "%seu# #e2anan s%s#o1%2 an21e.

    P%n"a!2an u== 2e 1en-an "% s%s% yan- sama "en-an e2s#$em%#as

    a9a!.

    @a$% pu1se $a!%a1 "en-an "op1e$ p$oe 2one2#%n- -e1/.

    Te2an u== !%n--a uny% pu1se men-!%1an-

    Tu$un2an #e2anan pe$1a!an !%n--a #e$"en-a$ uny% pu1se 1a-%, po%n#

    %n% "%seu# #e2anan s%s#o1%2 $a!%a1.

    H%#un- ABPI "en-an mema-% !as%1 s%s#o1%2 an21e "en-an !as%1

    s%s#o1%2 $a!%a1.

    Pe$!%#un-an

    ABI Pe$=us%on S#a#us

    *.) E1e?a#e", %nomp$ess%1e ?esse1s

    *.( No$ma1

    F(.> Lo9e$ E

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    . Pen-e1o1aan pa"a masa1a! yan- #%mu1 %n=e2s%, "11/.

    ". E"u2as% pe$a9a#an 2a2%.

    e. Peme$%an oa#3oa# yan- #epa# un#u2 %n=e2s% menu$u# !as%1

    1ao$a#o$%um 1en-2ap/ "an oa# ?as2u1a$%sas%, oa# un#u2 penu$unan -u1a

    "a$a! maupun men-!%1an-2an 2e1u!an6-e8a1a "an penyu1%# DM.

    =. O1a! $a-a #e$a#u$ "an men8a-a e$a# a"an %"ea1.

    -. Men-!en#%2an 2e%asaan me$o2o2.

    !. Me$a9a# 2a2% sea$a #e$a#u$ se#%ap !a$%, "en-an a$a :

    */ Se1a1u men8a-a 2a2% "a1am 2ea"aan e$s%!.

    7/ Meme$s%!2an "an menu% 2a2% se#%ap !a$% "en-an a%$ suam3suam 2u2u

    "en-an mema2a% saun 1emu# "an men-e$%n-2an "en-an sempu$na "an !a#%3!a#%

    #e$u#ama "%an#a$a 8a$%38a$% 2a2%.

    )/ Mema2a% 2$em 2a2% yan- a%2 pa"a 2u1%# yan- 2e$%n- a#au #um%# yan-

    $e#a23$e#a2, supaya 2u1%# #e#ap mu1us, "an 8an-an men--oso2 an#a$a 8a$%38a$% 2a2%

    on#o!: 2$em so$o1ene/.

    4/ T%"a2 mema2a% e"a2, sea %n% a2an menyea2an 2u1%# men8a"% 2e$%n-

    "an $e#a23$e#a2.

    / Men--un#%n- 2u2u !anya o1e! "%-una2an un#u2 memo#on- 2u2u 2a2%

    sea$a 1u$us "an 2emu"%an men-%2%$ a-a$ 1%%n. Memo#on- 2u2u 1e%! mu"a!

    "%1a2u2an sesu"a! man"%, se9a2#u 2u2u 1emu#.

    ;/ Ku2u 2a2% yan- menusu2 "a-%n- "an 2a1us, !en"a2nya "%oa#% o1e!

    po"%a#$%s#. Jan-an men--una2an p%sau u2u$ a#au p%sau %asa, yan- %sa #e$-e1%n%$

    "an %n% "apa# menyea2an 1u2a pa"a 2a2%. Jan-an men--una2an penu#up

    2o$nus6o$ns. Ko$nus32o$nus %n% se!a$usnya "%oa#% !anya o1e! po"%a#$%s#.

    5/ Meme$%2sa 2a2% "an e1a! 2a2% se#%ap !a$% apa2a! #e$"apa# 2a1us, u1a,1u2a "an 1ee#.

    22

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    +/ Men-!%n"a$% pen--unaan a%$ panas a#au an#a1 panas.

    %.pen--unaan a1as 2a2% yan- #epa# :

    T%"a2 o1e! e$8a1an #anpa a1as 2a2%, #e$masu2 "% pas%$.

    Mema2a% sepa#u yan- sesua% a#au sepa#u 2!usus un#u2 2a2% "an nyaman

    "%pa2a%.

    See1um mema2a% sepa#u, meme$%2a sepa#u #e$1e%! "a!u1u, 2a1au a"a a#u

    "an 1a%n31a%n, 2a$ena "apa# menyea2an %$%#as%6-an--uan "an 1u2a #e$!a"ap

    2u1%#.

    Sepa#u !a$us #e$ua# "a$% 2u1%#, 2ua#, pas u2up $uan- un#u2 %u 8a$% 2a2%/ "an

    #%"a2 o1e! "%pa2a% #anpa 2aus 2a2%.

    Sepa#u a$u !a$us "%pa2a% sea$a e$an-su$3an-su$ "an !a#%3!a#%.

    Mema2a% 2aus 2a2% yan- e$s%! "an men--an#% se#%ap !a$%. Kaus 2a2% #e$ua#

    "a$% a!an 9o1 a#au 2a#un. Jan-an mema2a% a!an s%n#e#%s, 2a$ena a!an %n%

    menyea2an 2a2% e$2e$%n-a#.

    Mema2a% 2aus 2a2% apa%1a 2a2% #e$asa "%n-%n.

    Men-!%n"a$% #$auma e$u1an-, #$auma "apa# e$upa =%s%2, 2%m%a "an #e$m%s,

    yan- %asanya e$2a%#an "en-an a2#%?%#as a#au 8en%s pe2e$8aan.

    Men-!%"a$% pema2a%an oa# yan- e$s%=a# ?aso2ons#$%2#o$ m%sa1nya a"$ena1%n,

    n%2o#%n.

    Meme$%2sa2an "%$% sea$a $u#%n 2e "o2#e$ "an meme$%2sa 2a2% se#%ap 2on#$o1

    9a1aupun u12us "%ae#%2 su"a! semu!

    De$%"emen# men8a"% sa1a! sa#u #%n"a2an yan- #e$pen#%n- "a1am pe$a9a#an 1u2a.

    De$%"emen# a"a1a! sua#u #%n"a2an un#u2 memuan- 8a$%n-an ne2$os%s, a11us "an 8a$%n-an

    23

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    =%$o#%2. Ja$%n-an ma#% yan- "%uan- se2%#a$ 73) mm "a$% #ep% 1u2a 2e 8a$%n-an se!a#.

    De$%"emen# men%n-2a#2an pen-e1ua$an =a2#o$ pe$#umu!an yan- meman#u p$oses

    penyemu!an 1u2a.

    Me#o"e "e$%"emen# yan- se$%n- "%1a2u2an ya%#u su$-%a1 s!a$p/, au#o1%#%2,

    en'%ma#%2, 2%m%a, me2an%s "an %o1o-%s. Me#o"e su$-%a1, au#o1%#%2 "an 2%m%a !anya

    memuan- 8a$%n-an ne2$os%s "e$%"emen# se1e2#%=/, se"an-2an me#o"e me2an%s

    memuan- 8a$%n-an ne2$os%s "an 8a$%n-an !%"up "e$%"emen# non se1e2#%=/.

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    DAFTAR P"STAKA

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    25

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    *(. @a1%=o$n%a Po"%a#$% Me"%a1 Asso%a#%on D%ae#% oun" @a$e. Me% 7(*4. A?a%1ae1 a# :

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    26

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    7*. Kusuma A. Huun-an an#a$a #e$8a"%nya neu$opa#% "%ae#%2a "en-an 1amanya men"e$%#a

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