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PRESENTASI KASUSPRESENTASI KASUS
HERNIAHERNIA
Oleh :
Hermawan Prasetya, S.KedPanji Indra Purnama, S.Ked
Suparyanto, S.Ked
Pembimbing :
Dr. Ahmad Haryadi, Sp.!
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STATUS PASIENSTATUS PASIEN
Identitas Pasien◦ Nama : Tn. AR
◦ Umur : 45 tahun
◦Jenis Kelamin : Laki-laki
◦ Pekerjaan : Buruh
◦ Agama : Islam
◦ Peniikan : !"P
◦ Alamat : #ik$neng% #iamis◦ Tanggal "asuk R! : & "aret '()*
◦ Jam "asuk R! : )+.5( ,IB
◦ N$. Rekam "eik : *(5')5
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Anamnesis
Keluhan Utama : Benj$lan i liat aha seelah kanan
Ri/a0at Pen0akit !ekarang :
Pasien atang engan keluhan teraat enj$lan i liat
aha seelah kanan sejak ) ulan !"R!. Benj$lanterseut terutama timul saat 1s eriri% mengean% an atuk. Benj$lan aat masuk aaila i$r$ng engantangan. Benj$lan tiak terasa sakit% tiak merah% an tiakterasa tegang.
1s mengeluh BAB sering keras an tiak lan2ar. BAKtiak aa keluhan. 1s juga tiak mengeluhkan aan0amual an muntah.
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Ri/a0at Pen0akit 3ahulu :
Ri/a0at en0akit hiertensi% iaetes mellitus% en0akit jantung% trauma a$men isangkal
Ri/a0at Pen0akit Keluarga :Tiak aa angg$ta keluarga 0ang menerita
en0akit 0ang sama engan 1s.
Ri/a0at Peng$atan :
1s elum ernah er$at seelumn0a.
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P"RIK!AAN I!IK P"RIK!AAN I!IK
Keaaan Umum : Tamak sakit seang
Kesaaran : #$m$s mentis
6ital !ign
◦ Tekanan arah : ))(78( mm9g
◦ Nai : +4 7menit
◦ Resirasi : '( 7menit
◦ !uhu : *&%+ #⁰
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Status Generalis
Kepala : N$rm$2ehal% /ajah simetris
Mata : #$njungti;a anemis <-7-=%s2lera ikterik <-7-=%
uil ulat is$k$r% re>lek 2aha0a <?7?=.
Hidung : 3e;iasi setum nasi <-=% is2harge <-7-=.
Telinga : Bentuk n$rmal% simetris kanan kiri%
is2harge <-7-=.
Mulut : Phar0ng hieremis <-=% emesarant$nsil<-=% liah k$t$r <-=.
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Leher
◦ Inseksi : Trakea i tengah% J6P meningkat <-=
◦ Palasi : Tiak teraa emesaran kelenjar
Thorax
Paru-paru
◦ Inseksi : Pergerakan simetris% retraksi inter2$stals <-=
◦ Palasi : 6$kal >remitus kanan @ kiri% n0eri tekan <-=%
tiak teraa massa.
◦ Perkusi : !$n$r i seluruh laang aru
◦ Auskultasi : ;esikuler <?7?=% /heeing <-7-=% r$n2hi <-7-=.
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!antung
◦
Inseksi : iktus 2$ris tiak terlihat◦ Palasi : iktus 2$ris teraa i I#! 6 L"#!
◦ Perkusi :
Batas atas sela iga II garis arasternal etra
Batas jantung kanan sela iga I6 garis arasternal etra
Batas jantung kiri sela iga I6 garis mi2la;i2ula sinistra
◦ Auskultasi : Bun0i jantung I-II reguler% murmur <-=%
gall$ <-=
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A"domen
◦
Inseksi : 3atar% arm 2$nt$ur <-=% arm stei>ung <-=.◦ Palasi : !uel% n0eri tekan <-=% massa <-=% hear7lien
tiak teraa.
◦ Perkusi : Timani i seluruh laang a$men.
◦ Auskultasi : Bising usus <?= n$rmal.
• Genitalia
• S#rotum
•Inseksi : Tiak tamak emesaran% tiak tamak
/arna kemerahan
•Palasi : Tiak teraa emesaran% n0eri tekan <-=
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E$stremitas :
◦ !ueri$r : eema <-7-=% sian$sis <-7-=
◦ In>eri$r : eema <-7-=% sian$sis <-7-=
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Status Lo$alis
◦ %egio Inguinalis &extra
◦ Inseksi : Tamak enj$lan i liat aha seelah
kanan% tiak er/arna merah% jejas <-=.
◦Palasi : Teraa enj$lan engan k$nsistensi lunak%n0eri tekan <-=
◦ Auskultasi : Bising usus <?=
◦ Perkusi : Tiak ilakukan.
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Pemeriksaan FisikPemeriksaan Fisik
Tambahan Tambahan Tes Valsava (+)Finger test (+)
Tes transiluminasi ()
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P"RIK!AAN PNUNJANP"RIK!AAN PNUNJAN
La$rat$rium :
◦ 9em$gl$in : )5%+ g7l
◦ Jumlah leuk$sit : )5.(((7 µl
◦ 9emat$krit : 48C
◦ Jumlah Tr$m$sit : '*(.((( 7 µl
◦ 3! : ))' mg73l
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3IAN1!I! KRJA
9ernia Inguinalis Lateralis 3etra
Re$nile
3IAN1!I! BAN3IN
◦ 6arik$kel
◦ 9ir$kel
◦ Lim>aen$ati Inguinal
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PNATALAK!ANAANPNATALAK!ANAAN
K$nser;ati>
"eikament$sa
◦ I63 RL '( gtt7menit
◦ Injeksi #e>$taime ) ) gram
1erati>
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Tinjauan PustakaTinjauan Pustaka
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Anat!miAnat!mi
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3INI!I
9ernia : Keluarn0a isi suatu r$ngga alam
tuuh melalui e>ek aa ining r$nggaterseut
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ETI'L'GIETI'L'GI
◦ K$ngenital
9ernia k$ngenital semurna
9ernia k$ngenital tiak semurna
◦ Akuisital
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Jenis-jenis 9erniaJenis-jenis 9ernia
Berasarkan Klinis :
◦ Re$niel
◦ Irre$niel
◦ !trangulasi
◦ Inkarserata
• Berasarkan Arah hernia :
• Interna
• ksterna
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Pat!"si!l!giPat!"si!l!gi
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DIA"#OSISDIA"#OSIS
Anamnesis
Pemeriksaan isik
◦ Inseksi
◦ Palasi
◦ Auskultasi
Tes 6alsa;a
inger testTes transiluminasi
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#lini$al %ra&ing#lini$al %ra&ing
Re&u$ti!n 'ain bstru$ti!n t!i$
%ra&e
re'!nible +
irre'!nible
in$ar$erati!n $!li$ +
strangulati!n stea&* +++ in$rease
leu$!$*t!sis
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3IAN1!I! BAN3IN3IAN1!I! BAN3IN
◦ 6arik$kel
◦ 9ir$kel
◦
Lim>aen$ati Inguinal
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PENATAAKSANAANPENATAAKSANAAN
,an*a !'erasi -
,erni!t!mi
,erni!'lasti
.aktu !'erasi -
Segera setelah ter&iagn!sa
'erasi &arurat-
Kalau ter/a&i inkarserasi
Inkarserasi - ter/a&i se0aktu0aktu
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E&uar&! 1assiniE&uar&! 1assini
,erni!rhha'*,erni!rhha'*
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#hester 1 2$Va*3 243 Ph4#hester 1 2$Va*3 243 Ph4
5678 (5678 (#!!'er9s ligament re'air#!!'er9s ligament re'air))
PE21A,ASANPE21A,ASAN
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PE21A,ASANPE21A,ASAN TERI
Anamnesis - 1en/!lan Pre&is'!sisi -
Usia Peker/aan
Pemeriksaan Fisik -• Ins'eksi• Pal'asi• Auskultasi
Tes 6alsa;a <?=inger test <?=
Tes transiluminasi <-=
KASUS
1en/!lan &i li'at'aha
Usia 7: tahun Peker/aan buruh
4iagn!sis -
,ernia Inguinalis ateralis4etra Re'!n!bel
Pemeriksaan Fisik -• Ins'eksi• Pal'asi• Auskultasi
Tes 6alsa;ainger test
Tes transiluminasi
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DA$%A& P'S%AKADA$%A& P'S%AKA
R; S/amsuhi&a/at < .im &e =!ng;1uku A/ar Ilmu 1e&ah; E&isi >;
Penerbit buku ke&!kteran E%#;
=akarta; ?858;Sabist!n;566:; 1uku A/ar 1e&ah
1agian 5; E%#; =akarta; ,lm -
56?@ ?75?7?;
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Terima Kasih Terima Kasih