8/17/2019 Case Chirrosis Hepatis
1/28
Chirrosis Hepatis e.c
Chronic Hepatitis B
Case Report : dr. Irwin Sp.PD
8/17/2019 Case Chirrosis Hepatis
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
8/17/2019 Case Chirrosis Hepatis
3/28
"namneseta,en on Th+rsda! -+ne %th $1
•
E n * a r # e d o 2 t h e
s t o m a c h s i n c e ' m o n t h ) e 2 o r e h o s p i t a * i 3 e dMain
Comp*ai
nt
• D ! s p n o e • N a + s e a • 4 e d e m i n ) o t h
e t r e m i t i e s"ddition
a*Comp*ai
nt
8/17/2019 Case Chirrosis Hepatis
4/28
Pict+re o2 the patient
8/17/2019 Case Chirrosis Hepatis
5/28
Histor! o2 Present Disease
Present condition o2 the patient started 6month a#o. 7hen he and his wi2e came toRS8D 9arawan# 2or ro+tine chec, +p 2or hisDM in Interna* Medicines c*inic.
That moment he admitted that his *e#s wasswo**en( he a*so said that his e!es and hiswho*e )od! was !e**ow in co*o+r. His stomachwas *itt*e en*ar#ed( )+t his wi2e tho+#ht that
was ;+st ordinar! )*oatin#.
"2ter eamination he was to*d that he #ot a*ier disease ndthat his HBs"# was positie.
8/17/2019 Case Chirrosis Hepatis
6/28
"2ter that he 2e*t that his stomach wasen*ar#in# more and more. He admitted thathe eperienced a omit containin# )*ood
and his stoo* was containin# )*ood too( )+ton*! once.
He #ot the Hepatitis B treatment( +nti* itsc+red. He to*d that his )od! was )ein#
s,inn! )+t the stomach ,ept en*ar#in# and)oth *e#s and hands were swo**en.
8/17/2019 Case Chirrosis Hepatis
7/28
Then he came a#ain to RS8D9arawan# and dia#nosed as ChirrosisHepatis.
He said that he has a paracintesis 'times 2rom ?e)r+ar!
8/17/2019 Case Chirrosis Hepatis
8/28
"2ter stopped )ein# a sai*or( he)ecame a tr+c, drier +nti* now. Headmitted that he o2ten dr+n, mied
a*coho* with his 2riends.
He a*so *i,ed to dr+n, a traditiona*drin,s and sodas. "nd he was a
smo,er 2or a)o+t '$ !ears.
8/17/2019 Case Chirrosis Hepatis
9/28
Histor
! o2Past
Disease
DM
8/17/2019 Case Chirrosis Hepatis
10/28
Histor! o2 ?ami*! Disease
DM
8/17/2019 Case Chirrosis Hepatis
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
@
8/17/2019 Case Chirrosis Hepatis
12/28
• Moderately ill
enera* appearance
• Compos mentis
Conscio+sness
enera* Conditionenera* Condition
8/17/2019 Case Chirrosis Hepatis
13/28
IT"/ SINS
B*oodPress+r
e
•
$&%$mmH#
HeartRate
• &
mins
RespirationRate
•
&mins
Temperat+re
• '%($
C
8/17/2019 Case Chirrosis Hepatis
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
8/17/2019 Case Chirrosis Hepatis
15/28
Thora Eamination
- /+n# eamination
•
Inspection : S!mmetrica*( retraction
8/17/2019 Case Chirrosis Hepatis
16/28
Thora Eamination
8/17/2019 Case Chirrosis Hepatis
17/28
"BD4MIN"/ E"MIN"TI4N
• Inspection : Brown s,in(distended ( s,in a)norma*it!
8/17/2019 Case Chirrosis Hepatis
18/28
8/17/2019 Case Chirrosis Hepatis
19/28
Extremity Examination (2)
Pa*mar Er!tema
8/17/2019 Case Chirrosis Hepatis
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 $(0 1(5 m#&d*
8/17/2019 Case Chirrosis Hepatis
21/28
Result Normal
HBs"# @
S4T L 0$ +&/
SPT 16 L 0$ +&/
Protein tota* %(' %(5 (5 m#K
"*)+min 1( '(5 5($ m#K
*o)+*in 0(5 (% '(% m#K
8/17/2019 Case Chirrosis Hepatis
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
8/17/2019 Case Chirrosis Hepatis
23/28
DiJerentia* Dia#nosis
Chirrosis
Hepatis e.c"*coho* and DMt!pe
Chirrosis
Hepatis e.cChronicHepatitis B and
DM t!pe
8/17/2019 Case Chirrosis Hepatis
24/28
7or,in# Dia#nosis
•Chirrosis Hepatis e.c Chronic
Hepatitis B•DM t!pe
8/17/2019 Case Chirrosis Hepatis
25/28
S+##ested Eamination
• 8S ")domen
• T
•
E9• Thora Photo
8/17/2019 Case Chirrosis Hepatis
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
8/17/2019 Case Chirrosis Hepatis
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
8/17/2019 Case Chirrosis Hepatis
28/28