CASE REPORT57 years old woman came to Moh. Hoesin Hospital with Chief Complaint Enlargement of Abdomen since + 1 days before admitted to the hospital.

zBy:

Priska Pramuji, S.Ked (04114705025)Sugianto Mukmin, S.Ked (04114708060)

Mentor:

Prof.dr.H.Eddy Mart Salim, Sp.PD, K-AI

Moderator:

Compulsory Opponent: Apriliza RalasatiFree Opponent: Reni Anggraini

Arafiah Namira

Dimas Agung

Isnugraika H.Utami Anita Revera Sari

M.Yusuf Fantoni Nur Anisa Aulia

HernaSatria Cynthia Lina O.

Meigi Medika Rima Zanaria

Richard Togi Lumban Tobing Umaimah Adilla

M.Giovanni

DEPARTEMENT OF INTERNAL MEDICINEMOEHAMMAD HOESIN GENERAL HOSPITAL

MEDICAL FACULTY OF SRIWIJAYA UNIVERSITY

2012CERTIFICATION PAGE

Case Report

Title

57 years old woman came to Moh. Hoesin Hospital with Chief Complaint General Body Weakness since + 1 days before admitted to the hospital.

Written by:

Priska Pramuji, S.Ked (04114705025)Sugianto Mukmin, S.Ked (04114708060)

Has been accepted and approved as one of the requirement in following the Senior Register in Departement of Internal Medicine, Faculty of Medicine Sriwijaya University Palembang, General Hospital Mohammad Hoesin Period September 3rd November 12thPalembang, 17th September 2012

Prof.dr.H.Eddy Mart Salim, Sp.PD, K-AI

CHAPTER IINTRODUCTIONCirrhosis hepatis is the final common histologic pathway for a wide variety of chronic liver disease. It is defined as a diffuse hepatic proccess characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. In addition to fibrosis, the complications of chirrhosis include, but are not limited to, portal hypertension, ascites, hepatorenal syndrome, and hepatic encephalopaty. Often poor correlation exist between histologic findings and clinical picture. Some patient may asymptomatic and have a reasonably normal life expectancy.Cirrhosis takes seventh place in the world for the common cause of death. About 25.000 people death everyday because of chirrhosis. It is more common in men than in women (1,6:1) with average age about 30-59 years old and peak of age 40-49 years old. Cirrhosis, is the terminal of hepatic fibrosis, cirrhosis takes 4,1 % prevalence in jogjakarta and in medan 4 %. For that reason, we want to discuss more about chirrhosis based on patient in Mohammad Hoesin. We present a case with chief complain of abdominal enlargement which we guess is a chirrhosis hepatis. Hope this discussion gives a lot of knowledge about disease that have high incidence rate.CHAPTER II

CASE REPORT1. Identification

Name

: Miss. M Age

: 57 years old Sex

: Female Address

: Tanjung Lubuk Status

: Married Occupation

: house wife Religion

:ISLAM Date of admission: September, 6th 20122.Anamnesis (Autoanamnesis at September, 8th 2012)Chief complaint: Enlargement of abdomen since + 1 days before admitted

Since + 16 days before admitted, patient complained pain in epigastrium region, pain wasnt radiated. There was no fever. There was nausea and vomit, the vomited material contain is the material what she ate previously, amount of vomit was 1 glass per day, frequency of vomit was 2 times, The patient also complained swelling of her abdomen, there was no problem with her appetite. The patient also complained oedema both of her leg, there was no pain of her leg. There is a problem with her urination, she said that she had tea-like urine. She had no problem with her defecation. She takes the medication without prescription by herself after buy the medication at hawker, she forgot the name of the medication.

Since + 1 day before admitted, patient complained general body weakness, the weakness happened all the time, the patient still complained pain in epigastrium, pain wasnt radiated, there wasnt fever. There was nausea, but no vomit, The patient also complained enlargement of her abdomen, there was no problem with her appetite. The patient also complained edema both of her leg. There is no problem with her urination and defecation, the patient comes to RSMH.Previous history Diagnose Hepatitis 1 year ago. Drink alcohol is denied

Herbal medicine was routinely taken since 2 times a month Hypertension history is denied

Using analgetic drug is denied Diabetic mellitus is denied

Family history

There was no patients family who had the same complain.

3.Physical ExaminationGeneral Condition

General appearance: She look moderately sickSense

: Compos mentisBlood pressure:110/70 mmHg

Body Weight: 50 kgPulse rate

: 80 x/m

Body Height: 150 cm

Temp (axilla)

: 36,9 oC

BMI

: 22,2 kg/cm2Respiration rate: 20 x/m

Specific Condition

Skin

: Yellow colored, icterus (+), cyanosis (-).

Lymph nodes: There are no enlargement of the lymph nodes on

submandibular, neck, axillaries and inguinal. Head

: Normocephaly, minimal hair loss, symmetrical,

alopecia (-), brittle hair (-), puffy face (-), deformity (-),

malar rash (-).

Eyes

: Exopthalmus or endopthalmus (-), pale conjunctivae

palpebrae (+), icteric sclera (+). Nose

: Epistaxis (-), normal nasal septum, normal mucous later. Ear

: Normal both of meatus accusticus externus, decreasing

hearing ability (-).

Mouth

: Stomatitis (-), enlargement of tonsil (-). Neck

: JVP (5-2) cmH2O, enlargement of lymph nodes (-), enlargement of thyroid glands (-).

Thorax

: Symetric, retraction (-).

Lungs

I: Static, dynamic, right and left lung symetric, no retraction. P: Stem fremitus right = left, no widenning of intercostal

Space, no tenderness. P: Sonor in both side of lungs

A: Vesicular (+) normal, ronchi (-), wheezing (-)

Cor

I: Ictus cordis cant be seen, no vosoure cardiac P:Ictus cordis cant be palpated, no thrill P: Upper border: ICS II

Right border: sternal dextra line

Left border: midclavicularis sinistra line

A: HR 90 x/m, murmur (-), gallop (-) Abdomen I: Convex, striae(-) P: Tender pain at palpation in epigastric region, hepar isnt

Palpable, lien isnt palpable. P: Undulation (-), Shifting dullness (+) A: Normal bowel sound

Upper and lower extremities : pretibial edema (+)4. Laboratory Findings

7th September 2012 in RSMH Hematology

Hemoglobin : 5,5 (F: 12-16 g/dl) moderate anemia

Leucocyte : 3200 (4000-10000)

Differential count

Basophil : 0(0- 1)

Eosinophil : 1(1- 3%) Stem

: 2(2- 6 %)

Segment: 47(50- 70 %)

Lymphocyte: 37(20- 40 %)

Monocyte: 13(2- 8%) increase

Hematocrit : 15 (38- 47 %) anemia

Trombocyte : 163 (150-450 106 ul)

Blood Chemistry Total bilirubin : (