kolelithiasis case

7/17/2019 Kolelithiasis Case

http://slidepdf.com/reader/full/kolelithiasis-case 1/25

BAGIAN ILMU BEDAH LAPORANKASUS

FAKULTAS KEDOKTERAN Mei 2015

UNIVERSITAS MUSLIM INDONESIA

KOLELITIASIS

DISUSUN OLEH:

Haerul A!ar

110 20" 00#0

SUPERVISOR :

$r%M%I!a Dai S&%B'KBD

BAGIAN ILMU BEDAH

FAKULTAS KEDOKTERAN

UNIVERSITAS MUSLIM INDONESIA

MAKASSAR

2015

0



BAB I

LAPORAN KASUS

A. IDENTITAS

Na(a : N)% Nur I*a

Ta++al La,ir : -1.12.1"/0

U(ur : 5# *a,u

RM : 1--55

MRS : 1"'0'201#

B. ANAMNESIS

• Keluhan Utama

N)eri &eru* aa a*a

• Riwayat Perjalanan Penyakit

Diala(i 3 1 *a,u )a+ lalu% N)eri $iraaa (e(4era* 1 (i++u e4elu(

(au ru(a, ai* )eri $iraaa ,ila+ *i(4ul *i$a $i&e+aru,i 6le,

&6ii $a a*i7i*a% N)eri $iraaa e&er*i *er*uu $a (e8alar e

&u++u+% N)eri a$a+ (u9ul e*ela, (e+6u(i (aaa 4erle(a

N)eri *i$a $ier*ai $e+a (ual *i$a (u*a,% De(a( *i$a a$a a$a

ri!a)a* $e(a( - ,ari )a+ lalu ri!a)a* ai* ui+ e4elu()a

$ia+al ri!a)a* +a*al &a$a 4a$a a$a e8a 5 ,ari )a+ lalu% BAB ea

6r(al!ara ui+% Ri!a)a* BAB !ara $e(&ul $ia+al% BAK ea

la9ar !ara ui+ 8eri,%

• Riwayat Penyakit Terahulu!Lainnya

' Ri!a)a* *rau(a $aera, &eru* $ia+al

' Ri!a)a* &e)ai* DM $a ,i&er*ei $ia+al

1



' Ri!a)a* &e)ai* )a+ a(a $ala( eluar+a $ia+al

". PEMERIKSAAN #ISIK

• Statu$ %enerali$

Sai* e$a+.+ii 9uu& . a$ar

• Statu$ &itali$

Teaa Dara, : 1-0.0((H+

Na$i : # ;.(ei*

Pera<aa : 1" ;.(ei*

Su,u : -/56=

Ke'ala

K68u+*i7a : Ae(i *i$a a$a

Slera : I*eru *i$a a$a

Bi4ir : Ti$a a$a ia6i

Gui : Per$ara,a *i$a a$a

Mata

&u&il 4ula* i66r > 25((.25(( R= ?.?

Paru

I&ei : Si(e*ri iri $a aa

Pal&ai : * i$a a$a )eri *ea *i$a a$a (aa *u(6r <6al

<re(i*u ra4a iri@aa

Perui : S66r R@L

Auul*ai : Bu)i &era&aa 7eiuler R@L

Bu)i *a(4a,a: r6,i '.' ,eei+ '.'

(antun)

I&ei : I9*u 96r$i *i$a *a(&a

Pal&ai : I9*u 96r$i *era4a $i I=S V (i$9la7i9ulari SC

Perui : Pea 4a*a 8a*u+ aa I=S 2 &ara*erali aa

4a*a

2



8a*u+ iri I=S VII - 8ari a(&i+ iri liea

(i$9la7i9ulari

Auul*ai : S1.S2 re+uler*i$a a$a (ur(ur

• Statu$ L*kali$

A+*men

I&ei : $a*ar iu* +era a<a !ara uli* a(a $e+a

ei*ar)a (aa *u(6r *i$a *a&a%

Auul*ai : &eri*al*i ea 6r(al

Pal&ai : )eri *ea &a$a ,i&66$riu( aa Mur&,)

i+ ?C ,e&ar $a lie *i$a a$a

Perui :*i(&ai )eri e*6 $i re+i6 ,i&66$riu(

aa%

D. PEMERIKSAAN PENUN(AN%

• Pemerik$aan La+*rat*rium ,-!!-/012

Pemerik$aan 3a$il Nilai n*rmal

4B" 5.6/ 7//80/7/

RB" .6- 7//897//

3%B 0: 0-7/8097/

3"T :6./ :;7/857/

PLT ::: 01/8//

Ureum 6 0/81/

Kreatinin /.6/ L,<07:2=

P,<0702

S%OT / < :5

S%PT :5 < 0

3+SA) N*n rea>ti?e N*n rea>ti?e

3



#*t* th*ra@ PA

' =6raa 4r69,67aular $ala( 4a*a

6r(al

' Ti$a *a(&a &r6e &ei<i a*i< &a$a

e$ua &aru

' =6r $ala( 4a*a 6r(al

' Siu $a $ia<ra+(a $ala( ea$a

6r(al

' Tula+'*ula+ i*a

' Kea :

' Ti$a a$a elaia &a$a <6*6 *,6ra; ii

US% ABDOMEN

Kea:

Ba*u &a$a 96llu( +all4la$er

E. Re$ume

4



Se6ra+ Pere(&ua $a*a+ e ru(a, ai* $e+a elu,a )eri &a$a

,i&66$riu( aa $iala(i 3 1*a,u )a+ lalu% N)eri $iraaa (e(4era* 1

(i++u e4elu( (au ru(a, ai* )eri $iraaa ,ila+ *i(4ul *i$a

$i&e+aru,i 6le, &6ii $a a*i7i*a% N)eri $iraaa e&er*i *er*uu $a

(e8alar e &u++u+% N)eri a$a+ (u9ul e*ela, (e+6u(i (aaa

4erle(a N)eri *i$a $ier*ai $e+a (ual *i$a (u*a,% De(a( *i$a a$a% a$a

ri!a)a* $e(a( - ,ari )a+ lalu ri!a)a* ai* ui+ $ia+al ri!a)a* +a*al

&a$a 4a$a e8a - ,ari )a+ lalu% BAB ea 6r(al!ara ui+% Ri!a)a*

BAB !ara $e(&ul $ia+al% BAK ea la9ar !ara ui+ 8eri,%

Dari ,ail &e(eriaa <ii &aie $a*a+ $e+a *a*u +eeral ai* e$a+

+ii 9uu& $a 96(&6 (e*i% Tea $ara, 1-0.0 ((H+ a$i # ali

&er(ei* &era<aa 1" ali &er(ei* $a u,u a<e4ri%

Pa$a &e(eriaa a4$6(e $i*e(ua i&ei $a auul*ai $ala(

4a*a 6r(al% Pa$a &e(eriaa &erui $i$a&a*a )eri e*6 &a$a

,i&66$riu( aa &al&ai $i*e(ua a$a)a )eri *ea $i ,i&66$riu(

aa $a Mur&,) i+ ?C% Pa$a USG a4$6(e $i$a&a*a Ba*u &a$a 96llu(+all4la$er%

#. DIA%NOSIS KER(A

=,6lei*6li*,iai

%. PENATALAKSANAAN

=,6lei*e9*6()

BAB II

TIN(AUAN PUSTAKA

5



A. PENDA3ULUAN

Pe)ai* 4a*u e(&e$u u$a, (eru&aa (aala, ee,a*a )a+ &e*i+

$i e+ara 4ara* e$a+a $i I$6eia 4aru (e$a&a*a &er,a*ia $i lii

e(e*ara &u4liai &eeli*ia 4a*u e(&e$u (ai, *er4a*a%Batu em'eu aalah

tim+unan kri$tal i alam kanun) em'eu atau i alam $aluran em'eu.

Batu yan) itemukan i alam kanun) em'eu i$e+ut k*lelitia$i$7

$ean)kan +atu i alam $aluran em'eu i$e+ut k*le*k*litia$i$.0

Ii$e 6leli*iai $i e+ara 4ara* a$ala, 20 e$a+a a+a e8a$ia

$i I$6eia *i$a 4er4e$a 8au, $e+a e+ara lai $i Aia Te++ara

)a(u,i$a)a*C% Pei+a*a ii$e 4a*u e(&e$u $a&a* $ili,a* $ala( el6(&6

rei6 *i++i )a+ $ie4u* # F : female fertile fat $a forty% Kau 4a*u e(&e$u

eri+ $i*e(ua $i A(eria )ai*u &a$a 10 a(&ai 20 &e$u$u $e!aa%Ba*u

e(&e$u le4i, eri+ *er8a$i &a$a !ai*a $ari &a$a lai'lai $e+a &er4a$i+a #

: 1% Di USA 10' 20 lai'lai $e!aa (e$eri*a 4a*u a$u+ e(&e$u $i I*alia

20 !ai*a $a 1# lai'lai $a e(e*ara $i I$6eia ,ail &eeli*ia

*er,a$a& &aie 6leli*iai )a+ $ira!a* $i Ru(a, Sai* U(u( Daera, Pr6<%

Mar+66 S6ear86 Pur!6er*6 $i$a&a*a 8u(la, &e$eri*a !ai*a 1 ali le4i,

4a)a $ari &a$a lai'lai%12-

Dua &er *i+a $ari 4a*u e(&e$u a$ala, ai(&*6(a*i $i(aa &aie *i$a

(e(&u)ai elu,a $a )a+ 4ere(4a+ (e8a$i )eri 6li *a,ua ,a)a 1'

#% Se(e*ara &aie $e+a +e8ala i(*6(a*i 4a*u e(&e$u (e+ala(i

6(&liai 12 $a 50 (e+ala(i )eri 6li &a$a e&i6$e ela8u*)a%2Rii6

&e)a$a+ 4a*u e(&e$u u*u (e+ala(i +e8ala $a 6(&liai rela*i< e9il%

alau&u $e(iia eali 4a*u e(&e$u (ei(4ula (aala, era+a )eri

6li )a+ &ei<i (aa rei6 u*u (e+ala(i (aala, $a &e)uli* aa *eru

(ei+a*%1-

Pa$a ei*ar 0 $ari au 6le*er6l (eru&aa 6(&6e *er4ear $ari

4a*u e(&e$u% Biaa)a 4a*u ' 4a*u ii 8u+a (e+a$u+ aliu( ar46a* <6<a*

a*au 4iliru4ia* *e*a&i 8ara+ 4a*u' 4a*u ii (uri $ari a*u 6(&6e a8a% #

6



Ba*u e(&e$u (eru&aa &e)ai* )a+ eri+ $i*e(ua $ie+ara (a8u

$a 8ara+ $i*e(ua $i e+ara'e+ara 4ere(4a+% De+a (e(4ai)a

ea$aa 6ial e66(i &eru4a,a (eu (aaa ala 4ara* er*a &er4aia

araa $ia+6i ,uu)a ul*ra66+ra<i &re7alei &e)ai* 4a*u e(&e$u

$ie+ara'e+ara 4ere(4a+ 9e$eru+ (ei+a*% Pe)ai* ii &erlu $i!a&a$ai

area ii$ei 4a*u e(&e$u $i Aia Te++ara ,uu)a $i I$6eia 9uu&

*i++i er*a e9e$eru+a &e)ai* ii u*u *er8a$i &a$a &aie 4eruia la8u*

)a+ 4iaa)a (e(ilii &e)ai* &e)er*a )a+ lai )a+ $a&a* (e(&er4uru

6$ii $a (e(&eruli* *era&i%5 Pe*i+ 4a+i $6*er u(u( u*u (e+e*a,ui

&e)ai* ii a+ar $a&a* (ee+aa $ia+6i e9ara *e&a* (elaua

&ea+aa &er*a(a (e(4eria &e8elaa )a+ 4ai e&a$a &aie $a

(eru8u e9ara *e&a*%5

B. ANATOMI DAN #ISIOLO%I KANDUN% EMPEDU

Ka$u+ e(&e$u (eru&aa a*6+ 4er4e*u e&er*i 4ua, al&ua* )a+

*erle*a *e&a* $i4a!a, l64u aa ,a*i%E(&e$u )a+ $ierei e9ara *eru

(eeru 6le, ,a*i (au e alura e(&e$u )a+ e9il $i $ala( ,a*i% Salura

e(&e$u )a+ e9il'e9il *ere4u* 4era*u (e(4e*u $ua alura )a+ le4i, 4ear

)a+ eluar $ari &er(uaa 4a!a, ,a*i e4a+ai $u*u ,e&a*iu aa $a iri

)a+ aa 4era*u (e(4e*u $u*u ,e&a*iu 6(ui% Du*u ,e&a*iu

6(ui 4er+a4u+ $e+a $u*u i*iu (e(4e*u $u*u 6le$6u%Pa$a

4a)a 6ra+ $u*u 6le$6u 4era*u $e+a $u*u &area*iu (e(4e*u

a(&ula Va*eri e4elu( 4er(uara e uu ,alu% Ba+ia *er(ial $ari e$ua

alura $a a(&ula $ielili+i 6le, era4u* 6*6* irular $ieal e4a+ai <i+*er

O$$i%-5

7



%am+ar 0%Aa*6(i a$u+ e(&e$u 5

A$a eua*u $aera, )a+ $i4e*u 6le, $u9*u 9)*iu =BD $a 9a4a+

ar*eri 9)*iu $ie4u* Tri+6u( =al6*. =,6le9)*6,e&a*i *ria+le $aera, ii

&e*i+ u*u i$e*i<iai ar*eri 9)*iu $a $u*u 9)*iu &a$a *i$aa

K6lei*e*6(i%-

Meuru* Gu)*6 Hall 1"" e(&e$u (elaua $ua <u+i &e*i+ )ai*u :

• E(&e$u (e(aia &eraa &e*i+ $ala( &e9eraa $a a46r&i

le(a area aa( e(&e$u )a+ (elaua $ua ,al a*ara lai: aa(

e(&e$u (e(4a*u (e+e(ulia &ar*iel'&ar*iel le(a )a+ 4ear

(e8a$i &ar*iel )a+ le4i, e9il $e+a 4a*ua ei( li&ae )a+

$iereia $ala( +e*a, &area Aa( e(&e$u (e(4a*u *ra&6r $a

8



a46r&i &r6$u a,ir le(a )a+ $i9era (eu8u $a (elalui (e(4ra

(u6a i*e*ial%

• E(&e$u 4eer8a e4a+ai ua*u ala* u*u (e+eluara 4e4era&a &r6$u

4ua+a )a+ &e*i+ $ari $ara, a*ara lai 4iliru4i ua*u &r6$u a,ir

$ari &e+,a9ura ,e(6+l64i$a ele4i,a 6le*er6l )a+ $i 4e*u

6le, el' el ,a*i%

E(&e$u $ialira e4a+ai ai4a* 6*rai $a &e+66+a &arial a$u+

e(&e$u% Pe+66+a a$u+ e(&e$u $i&e+aru,i 6le, ,6r(6 6lei*6ii

,al ii *er8a$i e*ia (aaa4erle(a (au e $u6$eu( ei*ar -0 (ei*

e*ela, (aa ,6r(6 e(u$ia (au e$ala( $ara, (e)e4a4a 6*rai

ri*(i $i$i+ a$u+ e(&e$u *e*a&i e<e*i<i*a &e+66+a 8u+a

(e(4u*u,a relaai )a+ 4era(aa $ari <i+*er 6$$i )a+ (e8a+a &i*u

eluar $u*u 4iliari 6(ui e$ala( $u6$eu( e,i++a (e(u+ia

(au)a e(&e$u )a+ e*al $ala( $u6$eu(% Gara('+ara( e(&e$u $ala(

9aira e(&e$u &e*i+ u*u e(uli<iai le(a $ala( uu ,alu $a (e(4a*u

&e9eraa $a a46r4i le(a% Selai 6lei*6ii a$u+ e(&e$u 8u+a

$ira+a+ ua* 6le, era*'era* ara< )a+ (e)erei ae*il6li $ari i*e(

ara< 7a+u $a e*eri% Ka$u+ e(&e$u (e+66+a i(&aa e(&e$u

&ea*)a e $ala($u6$eu( *eru*a(a e4a+ai re&6 *er,a$a& &era+a+a

6lei*6ii% Saa* le(a *i$a *er$a&a* $ala( (aaa &e+66+a a$u+

e(&e$u 4erla+u+ 4uru *e*a&i 4ila *er$a&a* 8u(la, le(a )a+ a$eua* $ala(

(aaa 6r(al)a a$u+ e(&e$u 66+ e9ara (e)eluru, $ala( !a*u

ei*ar 1 8a(%-/

Gara( e(&e$u lei*i $a 6le*er6l (eru&aa 6(&6e *er4ear

"0C 9aira e(&e$u%Sia)a a$ala, 4iliru4iaa( le(a $a +ara(

a6r+ai%Gara( e(&e$u a$ala, *er6i$ )a+ $i4ua* 6le, ,e&a*6i* $a 4eraal

$ari 6le*er6l% Pe+a*ura &r6$ui)a $i&e+aru,i (eai(e u(&a 4ali

)a+ $a&a* $i*i+a*a a(&ai 20 ali &r6$ui 6r(al alau $i&erlua%-

". DE#INISI

9



Ba*u E(&e$u $ie4u* 8u+a Si6i()a a$ala, 6leli*iai gallstones

biliarycalculus% I*ila, 6leli*iai $i(au$a u*u &e(4e*ua 4a*u $i

$ala( a$u+ e(&e$u% Ba*u a$u+ e(&e$u (eru&aa +a4u+a 4e4era&a

uur )a+ (e(4e*u ua*u (a*erial (iri& 4a*u )a+ *er4e*u $i $ala(

a$u+ e(&e$u%-5

D. ETIOLO%I

E(&e$u 6r(al *er$iri $ari 0 +ara( e(&e$u *eru*a(a 6li $a aa(

9,e6$e6;)9,6li9C 22 <6<6li&i$ lei*iC # 6le*er6l - &r6*ei $a 0-

4iliru4i%2E*i6l6+i 4a*u e(&e$u (ai, 4elu( $ie*a,ui $e+a e(&ura a(u

)a+ &ali+ &e*i+ a$ala, +a++ua (e*a46li(e )a+ $ie4a4a 6le,

&eru4a,a uua e(&e$u *ai e(&e$u $a i<ei a$u+ e(&e$u%-

Se(e*ara i*u 6(&6e u*a(a $ari 4a*u e(&e$u a$ala, 6le*er6l )a+

4iaa)a *e*a& 4er4e*u 9aira% ia 9aira e(&e$u (e8a$i 8eu, area

6le*er6l (aa 6le*er6l 4ia (e8a$i *i$a laru* $a (e(4e*u e$a&a $i

luar e(&e$u%-5/

E. #AKTOR RESIKO

K6leli*iai $a&a* *er8a$i $e+a a*au *a&a <a*6r rei6 $i4a!a,

ii%Na(u e(ai 4a)a <a*6r rei6 )a+ $i(ilii ee6ra+ e(ai 4ear

e(u+ia u*u *er8a$i)a 6leli*iai% Fa*6r rei6 *ere4u* a*ara lai :

-/"C

1% ai*a 4erei6 $ua 8a$i le4i, 4ear $i4a$i+ lai'laiC% Ii

$iareaaa 6le, ,6r(6 e*r6+e 4er&e+aru, *er,a$a& &ei+a*a

erei 6le*er6l 6le, a$u+ e(&e$u% Ke,a(ila )a+ (ei+a*a

a$ar e*r6+e 8u+a (ei+a*a rei6 *erea 6leli*iai% Pe++uaa

&il 6*rae&i $a *era&i ,6r(6 e*r6+eC $a&a* (ei+a*a 6le*er6l

$ala( a$u+ e(&e$u $a &eurua a*i7i*a &e+66+a a$u+

e(&e$u%

2% Uia le4i, $ari #0 *a,u %

10



-% Ke+e(ua 64ei*aC% Ii $iareaa e+e(ua $a&a* (e+ai4a*a

a$ar 6le*er6l $ala( a$u+ e(&e$u (ei+a* $a 8u+a $a&a*

(e+ura+i 6*rai. &e+66+a a$u+ e(&e$u%

#% Fa*6r e*urua

5% A*i7i*a <ii% Kura+)a a*i7i*a <ii 4er,u4u+a $e+a &ei+a*a

rei6 *er8a$i)a 6leli*iai% Ii (u+ $ie4a4a 6le, a$u+ e(&e$u

le4i, e$ii* 4er6*rai%

/% Hi&erli&i$e(ia

% Die* *i++i le(a $a re$a, era*

% Pe+66+a la(4u+ )a+ (e(a8a+

"% Nu*rii i*ra7ea 8a+a la(a

10% Di(6*ili*a a$u+ e(&e$u

11% O4a*'64a*a a*i,i&erli&e$(ia 9l6<i4ra*eC

12% Pe)ai* lai e&er*i Fi4r6i i*i Dia4e*e (elli*u ir6i ,a*i

&area*i*i $a aer a$u+ e(&e$uC $a &e)ai* ileu eura+a

+ara( e(&e$uC

1-% Ra.e*i Ii$ei)a *i++i &a$a I$ia A(eria $iiu*i 6le, uli* &u*i,

4aru 6ra+ A<riaC

#. PATO#ISIOLO%I

Pe(4e*ua 4a*u e(&e$u $i4a+i (e8a$i *i+a *a,a&: 1C &e(4e*ua

e(&e$u )a+ u&era*urai 2C uleai a*au &e(4e*ua i*i 4a*u $a -C

4ere(4a+ area 4er*a(4a,)a &e+e$a&a% Kelaru*a 6le*er6l (eru&aa

(aala, )a+ *er&e*i+ $ala( &e(4e*ua e(ua 4a*u e9uali 4a*u

&i+(e%Su&era*urai e(&e$u $e+a 6le*er6l *er8a$i 4ila &er4a$i+a aa(

e(&e$u $a <6<6li&i$ *eru*a(a lei*iC $e+a 6le*er6l *uru $i 4a!a, ,ar+a

*er*e*u%Se9ara 6r(al 6le*er6l *i$a laru* $ala( (e$ia )a+ (e+a$u+

air%E(&e$u $i&er*a,aa $ala( 4e*u 9air 6le, &e(4e*ua 6l6i$ )a+

(e(&u)ai i*i e*ral 6le*er6l $ielili+i 6le, (a*el )a+ ,i$r6<ili $ari

+ara( e(&e$u $a lei*i% a$i erei 6le*er6l )a+ 4erle4i,a a*au a$ar

11



aa( e(&e$u re$a, a*au *er8a$i erei lei*i (eru&aa ea$aa )a+

li*6+ei%-

Pe(4e*ua 4a*u $i(ulai ,a)a 4ila *er$a&a* ua*u i$u a*au i*i

&e+e$a&a 6le*er6l% Pa$a *i+a* u&era*urai 6le*er6l ri*al 6le*er6l

eluar $ari laru*a (e(4e*u ua*u i$u $a (e(4e*u ua*u &e+e$a&a%

Pa$a *i+a* a*urai )a+ le4i, re$a, (u+i 4a*eri <ra+(e &arai* e&i*el

el )a+ le&a a*au &ar*iel $e4ri )a+ lai $i&erlua u*u $i&aai e4a+ai

4ei, &e+ri*ala% "10

Ba*u e(&e$u ,a(&ir elalu $i4e*u $ala( a$u+ e(&e$u $a 8ara+

$i4e*u &a$a 4a+ia alura e(&e$u lai% E*i6l6+i 4a*u e(&e$u (ai, 4elu(

$ie*a,ui e&eu,)a aa *e*a&i *a(&a)a <a*6r &re$i&6ii *er&e*i+

a$ala, +a++ua (e*a46li(e )a+ (e)e4a4a *er8a$i)a &eru4a,a

6(&6ii e(&e$u *ai e(&e$u $a i<ei a$u+ e(&e$u%-"10

Peru4a,a 6(&6ii e(&e$u e(u+ia (eru&aa <a*6r *er&e*i+

$ala( &e(4e*ua 4a*u e(&e$u% Se8u(la, &e)eli$ia (eu8ua 4a,!a

,a*i &e$eri*a 4a*u e(&e$u 6le*er6l (e)erei e(&e$u )a+ a+a* 8eu,

$e+a 6le*er6l% K6le*er6l )a+ 4erle4i,a ii (e+e$a& $ala( a$u+

e(&e$u $e+a 9ara )a+ 4elu( $i(e+er*i e&eu,)aC u*u (e(4e*u 4a*u

e(&e$u% -"10

S*ai e(&e$u $ala( a$u+ e(&e$u $a&a* (e+ai4a*a u&era*urai

&r6+rei< &eru4a,a uua i(ia $a &e+e$a&a uur *ere4u*% Ga++ua

6*rai a$u+ e(&e$u a*au &a(e <i+*er O$$i a*au e$ua)a $a&a*

(e)e4a4a *ai% Fa*6r ,6r(6al *eru*a(a ela(a e,a(ilaC $a&a*

$iai*a $e+a &erla(4a*a &e+66+a a$u+ e(&e$u $a (e)e4a4a

*i++i)a ii$ei $ala( el6(&6 ii% -"10

I<ei 4a*eri $ala( alura e(&e$u $a&a* 4er&era $ala( &e(4e*ua

4a*u% Muu (ei+a*a 7i6i*a e(&e$u $a uur el a*au 4a*eri $a&a*

4er&era e4a+ai &ua* &rei&i*ai% Aa *e*a&i i<ei (u+i le4i, eri+

*i(4ul e4a+ai ai4a* $ari *er4e*u)a 4a*u e(&e$u $i4a$i+a e4a+ai

&e)e4a4 *er4e*u)a 4a*u e(&e$u% -"10

12



%. KLASI#IKASI

Meuru* +a(4ara (ar66&i $a 6(&6ii i(ia)a 4a*u e(&e$u $i

+6l6+aa a*a - *i+aC +6l6+a:1 -"10

0. Batu k*le$ter*l

Ber4e*u 67al (ul*i<6al a*au mulberry $a (e+a$u+ le4i, $ari 0

6le*er6l%Le4i, $ari "0 4a*u e(&e$u a$ala, 6le*er6l 4a*u )a+

(e+a$u+ J 50 6le*er6lC% U*u *er4e*u)a 4a*u 6le*er6l

$i&erlua - <a*6r u*a(a :

o Su&era*urai 6le*er6l

o Hi&6(6*ili*a a$u+ e(&e$u

o Nuleai. &e(4e*ua i$u 9e&a*%

K,uu (e+eai uleai 9e&a* eara+ *ela, *er4u*i 4a,!a e(&e$u

&aie $e+a 6leli*ia (e(&u)ai a* )a+ (e(&er9e&a* !a*u uleai

6le*er6l &r6(6*6rC e$a+a e(&e$u 6ra+ 6r(al (e+a$u+ a* )a+

(e+,ala+i *er8a$i)a uleai%

-. Batu 'i)men

Ba*u &i+(e (eru&aa 10 $ari *6*al 8ei 4a*u e(&e$u )a+ (e+a$u+

20 6le*er6l% ei)a a*ara lai:

a% Ba*u &i+(e aliu( 4iliru4ia &i+(e 96la*C

Ber!ara 96la* a*au 96la* *ua lua (u$a, $i,a9ura $a

(e+a$u+ aliu('4iliru4ia* e4a+ai 6(&6e u*a(a%Ba*u &i+(e

96ela* *er4e*u ai4a* a$a)a <a*6r *ai $a i<ei alura

e(&e$u%S*ai $a&a* $ie4a4a 6le, a$a)a $i<u+i <i+*er O$$i

*ri*ur 6&erai 4ilier $a i<ei &arai*% Bila *er8a$i i<ei alura

e(&e$u ,uu)a E% =6li a$ar ei( B'+lu6r6i$ae )a+ 4eraal

$ari 4a*eri aa $i,i$r6liai (e8a$i 4iliru4i 4e4a $a aa(

+lu6r6a*% Kaliu( (e+ia* 4iliru4i (e8a$i aliu( 4iliru4ia* )a+

*i$a laru*%Dari &eeli*ia )a+ $ilaua $i$a&a*a a$a)a ,u4u+a

era* a*ara i<ei 4a*eri $a *er4e*u)a 4a*u &i+(e 96ela*%u(u()a

4a*u &i+(e 96ela* ii *er4e*u $i alura e(&e$u $ala( e(&e$u )a+

*eri<ei%

13



4% Ba*u &i+(e ,i*a(%

Ber!ara ,i*a( a*au ,i*a( e96la*a *i$a 4er4e*u e&er*i 4u4u

$a a)a aa ia a* ,i*a( )a+ *a *ere*rai% 1 Ba*u &i+(e ,i*a(

a$ala, *i&e 4a*u )a+ 4a)a $i*e(ua &a$a &aie $e+a ,e(6lii

r6i a*au ir6i ,a*i% Ba*u &i+(e ,i*a( ii *eru*a(a *er$iri $ari $eri7a*

polymerized bilirubin% P6*6+eei *er4e*u)a 4a*u ii 4elu( 8ela%

U(u()a 4a*u &i+(e ,i*a( *er4e*u $ala( a$u+ e(&e$u $e+a

e(&e$u )a+ *eril%1-

:. Batu >am'uran

Ba*u 9a(&ura a*ara 6le*er6l $a &i+(e $i(aa (e+a$u+

20'50 6le*er6l%

14



%am+ar -% Klai<iai 4a*u $ala( a$u+ e(&e$u-

3. DIA%NOSIS

0. Anamne$i$

Se*e+a, a(&ai $ua &er*i+a &e$eri*a 6leli*iai a$ala,

ai(*6(a*i%Kelu,a )a+ (u+i *i(4ul a$ala, $i&e&ia )a+ a$a+

$ier*ai i*6lera *er,a$a& (aaa 4erle(a%Pa$a )a+ i(*6(a*i elu,a

u*a(a 4eru&a )eri $i $aera, e&i+a*riu( ua$ra aa a*a a*au

&eri6$riu(% Raa )eri lai)a a$ala, 6li 4ilier )a+ (u+i

4erla+u+ le4i, $ari 15 (ei* $a a$a+ 4aru (e+,ila+ 4e4era&a 8a(

e(u$ia% Ti(4ul)a )eri e4a)aa &erla,a'la,a *e*a&i &a$a -0 au

*i(4ul *i4a'*i4a%-

Pe)e4ara )eri &a$a &u++u+ 4a+ia *e+a, a&ula a*au e

&u9a 4a,u $ier*ai (ual $a (u*a,%Le4i, ura+ e&ere(&a* &e$eri*a

(ela&6ra 4a,!a )eri 4erura+ e*ela, (e++uaa a*ai$a% Kalau

*er8a$i 6leli*iai elu,a )eri (ee*a& $a 4er*a(4a, &a$a !a*u (eari

a<a $ala(%-

-. Pemerik$aan #i$ik

a% Ba*u a$u+ e(&e$u

A&a4ila $i*e(ua elaia 4iaa)a 4er,u4u+a $e+a

6(&liai e&er*i 6lei*i*i au* $e+a &eri*6i*i l6al a*au u(u(

,i$r6& a$u+ e(&e$u e(&ie(a a$u+ e(&e$u a*au &are*i*i%Pa$a &e(eriaa $i*e(ua )eri *ea $e+a &u*u( (ai(u( $i$aera,

le*a aa*6(i a$u+ e(&e$u% Ta$a Mur&,) &6i*i< a&a4ila )eri *ea

4er*a(4a, e!a*u &e$eri*a (eari a<a &a8a+ area a$u+

e(&e$u )a+ (era$a+ *ere*u, u8u+ 8ari *a+a &e(eria $a &aie

4er,e*i (eari a<a%-

4% Ba*u alura e(&e$u

15



Baru alura e(&e$u *i$a (ei(4ula +e8ala $ala( <ae

*ea+%Ka$a+ *era4a ,a*i $a lera i*eri% Perlu $i*a,ui 4a,!a 4ila

a$ar 4iliru4i $ara, ura+ $ari - (+.$l +e8al i*eri *i$a 8ela% A&a4ila

u(4a*a alura e(&e$u 4er*a(4a, 4era* aa *i(4ul i*eru lii%-

:. Pemerik$aan Penunjan)

a% Pe(eriaa la46ra*6riu(

Ba*u a$u+ e(&e$u )a+ ai(*6(a*i u(u()a *i$a

(eu8ua elaia &a$a &e(eriaa la46ra*6riu(%A&a4ila *er8a$i

&era$a+a au* $a&a* *er8a$i leu6i*6i% A&a4ila *er8a$i i$r6(a

(irii aa $i*e(ua eaia ri+a 4iliru4i eru( ai4a* &eeaa

$u*u 6le$uu 6le, 4a*u% Ka$ar 4iliru4i eru( )a+ *i++i (u+i

$ie4a4a 6le, 4a*u $i $ala( $u*u 6le$uu% Ka$ar <6<a*ae alali

eru( $a (u+i 8u+a a$ar a(ilae eru( 4iaa)a (ei+a* e$a+

e*ia& e*ia& ali *er8a$i era+a au*%-

4% Pe(eriaa Ra$i6l6+i

F6*6 &6l6 a4$6(e 4iaa)a *i$a (e(4eria +a(4ara )a+ ,a

area ,a)a ei*ar 10'15 4a*u a$u+ e(&e$u )a+ 4eri<a*

ra$i66&a%Ka$a+ a$u+ e(&e$u )a+ (e+a$u+ 9aira e(&e$u

4era$ar aliu( *i++i $a&a* $ili,a* $e+a <6*6 &6l6% Pa$a &era$a+a

au* $e+a a$u+ e(&e$u )a+ (e(4ear a*au ,i$r6& a$u+

e(&e$u a$a+ *erli,a* e4a+ai (aa 8ari+a lua $i ua$ra aa

a*a )a+ (eea +a(4ara u$ara $ala( uu 4ear $i <leura

,e&a*ia%-

16



%am+ar :% F6*6 r6+e* &a$a 6leli*iai 10

9% Pe(eriaa Ul*r666+ra<i USGC

Ul*ra66+ra<i (e(&u)ai $era8a* &ei<ii*a $a ei*i<i*a )a+

*i++i u*u (e$e*ei 4a*u a$u+ e(&e$u $a &ele4ara alura

e(&e$u i*ra,e&a*i (au&u e*ra ,e&a*i% De+a USG 8u+a $a&a*

$ili,a* $i$i+ a$u+ e(&e$u )a+ (ee4al area <i4r6i a*au u$e(

)a+ $iai4a*a 6le, &era$a+a (au&u e4a4 lai% Ba*u )a+ *er$a&a*

&a$a $u*u 6le$uu $i*al a$a+ uli* $i$e*ei area *er,ala+ 6le,

u$ara $i $ala( uu%De+a USG &u*u( (ai(u( raa )eri &a$a

4a*u a$u+ e(&e$u )a+ +a++re le4i, 8ela $ari&a$a $e+a &al&ai

4iaa%-

17

http://bp3.blogger.com/_slaDH4_nRyc/R77SZ9roZiI/AAAAAAAAAIg/U7fawWEtavA/s1600-h/kole+-+rongent.JPG



%am+ar %F6*6USG &a$a 6leli*iai -

$% K6lei*6+ra<i

U*u &e$eri*a *er*e*u 6lei*6+ra<i $e+a 6*ra 9uu& 4ai

area rela*i< (ura, e$er,aa $a 9uu& aura* u*u (eli,a* 4a*u

ra$i6lue e,i++a $a&a* $i,i*u+ 8u(la, $a uura 4a*u%

K6lei*6+ra<i 6ral aa +a+al &a$a ea$aa ileu &arali*i (u*a, a$ar

4iliru4u eru( $ia*a 2 (+.$l 6*rui &il6ru $a ,e&a*i*i area &a$a ea$aa'ea$aa *ere4u* 6*ra *i$a $a&a* (e9a&ai ,a*i%

Pe(eriaa 6lei*6+ra<i 6ral le4i, 4er(aa &a$a &eilaia <u+i

a$u+ e(&e$u%-

I. PENATALAKSANAAN

Peaa+a &r6<ila*i u*u 4a*u e(&e$u ai(*6(a*i *i$a $ia8ura%

N)eri )a+ ,ila+'*i(4ul 4ia $i,i$ari a*au $iura+i $e+a (e+,i$ari a*au

(e+ura+i (aaa 4erle(a%-Se4a+ia 4ear &aie $e+a 4a*u ai(*6(a*i

*i$a aa (e+ala(i elu,a% u(la, 4ear $a 6(&6ii 4a*u *i$a

4er,u4u+a $e+a *i(4ul)a elu,a ela(a &e(a*aua% Kalau&u a*i

*i(4ul elu,a u(u()a ri+a e,i++a &ea+aa $a&a* ele*i<% -10

Ha)a e4a+ia e9il )a+ aa (e+ala(i i(&*6( au*% Bila *ela, *er8a$i

6lei*i*i au* $i4eria &e+64a*a u(u( *er(au i*ira,a* *6*al &e(4eria

u*rii &are*eral $ie* ri+a 64a* &e+,ila+ raa )eri e&er*i &e*i$i $a

a*i&a(6$i% Pe(4eria a*i4i6*i &a$a <ae a!al a+a* &e*i+ u*u

(e9e+a, 6(&liai &eri*6i*i 6la+i*i $a e&*ie(ia% G6l6+a a(&iili

e<al6&6ri $a (e*r6i$a6l 9uu& (e(a$ai u*u (e(a*ia u(a'u(a

)a+ u(u( *er$a&a* &a$a 6lei*i*i au* e&er*i E. Coli Strep. Faecalis $a

Klabsiella.1-"10

U*u 4a*u a$u+ e(&e$u i(*6(a*i (aa $ia8ura u*u (e8alai

&e+a+a*a a$u+ e(&e$u 6lei*e*6(iC% Pe+a+a*a a$u+ e(&e$u

*i$a (e)e4a4a eura+a a* +ii $a e*ela, &e(4e$a,a *i$a &erlu

$ilaua &e(4a*aa (aaa% -

Pili,a &ea*alaaaa a*ara lai :10

18



1% K6lei*e*6(i *er4ua

K6(&liai )a+ &ali+ 4er(aa )a+ $a&a* *er8a$i a$ala, 9e$era $u*u

4iliari )a+ *er8a$i &a$a 02 &aie% A+a (6r*ali*a )a+ $ila&6ra

u*u &r6e$ur ii ura+ $ari 05% I$iai )a+ &ali+ u(u( u*u

6lei*e*6(i a$ala, 6li 4iliari reure $iiu*i 6le, 6lei*i*i au*%10

2% K6lei*e*6(i la&ara6&i

O&erai ii (eru&aa *a$ar *er4ai u*u &ea+aa &aie $e+a

6leli*iai i(*6(a*i% K6lei*e*6(i la&ar66&i (ulai $i&ereala

&a$a *a,u 1""0 $a eara+ ii ei*ar "0 6lei*e*6(i $ilaua e9ara

la&ar66&i%Sei*ar 0'"0 4a*u e(&e$u $i I++ri $i4ua+ $e+a 9ara ii

area (e(&ere9il rei6 e(a*ia $i4a$i+ 6&erai 6r(al 01'05

u*u 6&erai 6r(alC $e+a (e+ura+i 6(&liai &a$a 8a*u+ $a &aru%2

Ka$u+ e(&e$u $ia+a* (elalui ela+ )a+ $i(aua le!a* a)a*a

e9il $i $i$i+ &eru*% 10

I$iai a!al ,a)a &aie $e+a 6leli*iai i(*6(a*i *a&a a$a)a

6lei*i*i au*%Karea e(ai 4er*a(4a,)a &e+ala(a 4a)a a,li

4e$a, (ulai (elaua &r6e$ur ii &a$a &aie $e+a 6lei*i*i au* $a

&aie $e+a 4a*u $u*u 6le$6u%Se9ara *e6ri*i eu*u+a *i$aa ii

$i4a$i+a &r6e$ur 67ei6al a$ala, $a&a* (e+ura+i &era!a*a $i

ru(a, ai* $a 4ia)a )a+ $ieluara &aie $a&a* 9e&a* e(4ali 4eer8a

)eri (euru $a &er4aia 6(e*i%Maala, )a+ 4elu( *er&e9a,a

a$ala, ea(aa $ari &r6e$ur ii 4er,u4u+a $e+a ii$e 6(&liai

e&er*i 9e$era $u*u 4iliari )a+ (u+i $a&a* *er8a$i le4i, eri+ ela(a

6lei*e*6(i la&ara6&i% 10

%am+ar 1% K6lei*e*6(i la&ara6&i

19



-% Di6lui (e$i

Maala, u(u( )a+ (e++a++u e(ua a* )a+ &era, $i+uaa

a$ala, a+a ea(4u,a )a+ *i++i $a 4ia)a )a+ $ieluara% a*

$i6lui ,a)a (e(&erli,a*a (a<aa*)a u*u 4a*u e(&e$u 8ei

6le*er6l%Peeli*ia &r6&e*i< a9a $ari aa( ;e6$e6i6la* *ela,

(e+i$iaia 4a,!a $i6lui $a ,ila+)a 4a*u e9ara le+a& *er8a$i

ei*ar 15% ia 64a* ii $i,e*ia ea(4u,a 4a*u *e8a$i &a$a 50

&aie%10 Kura+ $ari 10 4a*u e(&e$u $ilaua 9ara ii a ue% 2

Di6lui (e$i e4elu()a ,aru (e(eu,i 9ri*eria *era&i 6 6&era*i<

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<u+i a$u+ e(&e$u 4ai $a $u*u i*i &a*e% 2

#% Di6lui 6*a

Mei&u &e+ala(a (ai, *er4a*a i<u &elaru* 6le*er6l )a+ &6*e

Metil-Ter-Butil-Eter MTBECC e $ala( a$u+ e(&e$u (elalui a*e*er

)a+ $ile*aa &er u*a *ela, *erli,a* e<e*i< $ala( (elaru*a 4a*u

e(&e$u &a$a &aie'&aie *er*e*u% Pr6e$ur ii i7ai< $a eru+ia

u*a(a)a a$ala, a+a ea(4u,a )a+ *i++i 50 $ala( 5 *a,uC% 10

5% Li*6*ri&i Gel6(4a+ Ele*r6)6 ESLC

Sa+a* &6&uler $i+uaa 4e4era&a *a,u )a+ lalu aalii 4ia)a'

(a<aa* &a$a aa* ii (e(&erli,a*a 4a,!a &r6e$ur ii ,a)a *er4a*a

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ii% 10

20



%am+ar 9%Li*6*ri&i Gel6(4a+ Ele*r6)6 ESLC

/% K6lei*6*6(i

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a(&i+ *e(&a* *i$ur &aie *eru 4erla8u* e4a+ai &r6e$ur )a+

4er(a<aa* *eru*a(a u*u &aie )a+ ai*)a ri*i%10

% E$696&i9 Re*r6+ra$e =,6la+i6&a9rea*6+ra&,) ER=PC

Pa$a ER=P ua*u e$66& $i(aua (elalui (ulu* er6+6+a

la(4u+ $a e $ala( uu ,alu% a* 6*ra ra$i66&a (au e $ala(

alura e(&e$u (elalui e4ua, ela+ $i $ala( <i+*er 6$$i% Pa$a

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*ela, 4er,ail $ilaua &a$a "0 au% Kura+ $ari # $ari e*ia& 1%000

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4iaa)a e<e*i< $ilaua &a$a &e$eri*a 4a*u alura e(&e$u )a+ le4i,

*ua )a+ a$u+ e(&e$u)a *ela, $ia+a*%12-

%am+ar ;%E$696&i9 Re*r6+ra$e =,6la+i6&a9rea*6+ra&,) ER=PC 12

(. KOMPLIKASI

K6(&liai )a+ $a&a* *er8a$i &a$a &e$eri*a 6leli*iai :-

1% Ai(*6(a*i

2% O4*rui $u*u i*iu

-% K6li 4ilier

21



#% K6lei*i*i au*

5% Peri6lei*i*i

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% Per<6rai

% K6lei*i*i r6i

"% Hi$r6& a$u+ e(&e$u

10% E(&ie(a a$u+ e(&e$u

11% Fi*el 6lei*6e*eri

12% Ba*u e(&e$u eu$er Pa$a 2'/ &e$eri*a alura (e9iu* e(4ali $a

4a*u e(&e$u (u9ul la+iC a++a

1-% Ileu 4a*u e(&e$u gallstone ileusC

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(ee*a& a*au&u $a&a* *erle&a la+i% A&a4ila 4a*u (eu*u&i $u*u i*iu e9ara

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23

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1119388

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1119388



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