Case Kawasaki Disease Word

8/12/2019 Case Kawasaki Disease Word

1/31

FAKULTAS KEDOKTERAN UKRIDA(UNIVERSITAS KRISTEN KRIDA WACANA)

Jl. Arjuna Utara No.6 Keon Jeru! " Ja!arta #arat

KEPANITERAAN KLINIK

STATUS ILMU KESEHATAN ANAK

FAKULTAS KEDOKTERAN UKRIDA

SMF ILMU PENYAKIT ANAKRUMAH SAKIT RAJAWALI, BANDUNG

Nama Mahasiswa : Nuu! Na"iha #i$%i N&& A'ha Ta$(a Ta$)a$:

NIM : **+-**+*.*

D&/%0 P0m#im#i$) : (1 Ra((2 Imawa$, S3A

IDENTITAS PASIEN

Na$a len%!a& ' An. F Jen !ela$n ' La!*la!

Tan%%al la+r,U$ur ' U$ur ' - ta+un

Su!u an%a ' A%a$a ' Ila$

en//!an ' SD !ela 0 Ala$at ' ur C&a%eran In/a+ C0*123 RT

45,04uun%an /en%an oran% tua ' ana! !an/un%

ANAMNESIS

Da$l /ar alloana$ne /an autoana$ne &a/a tan%%al 17 O!toer 04103 ja$ 1044

K0!uha$ u%ama

1 8 a % e


2/31

Ke/ua $ata $era+ eja! 5 +ar S9RS

Riwa2a% P0$2a/i% S0/aa$)

Ana! /atan% !e &ol ana! RS Raja:al /en%an !elu+an !e/ua $atan;a $era+. 9atan;a

$ula $era+3 %atal /an t$ul ele!an eja! 5 +ar eelu$ /atan% !e &ol. 9ata $era+ /erta

ara:an / r /an a/an &ana. Setela+ 1 +ar $atan;a $era+3 t$ul ara:an / r ana!

/an a/ann;a $ula teraa &ana. ana a/an e&anjan% +ar3 &ana $ala$ +ar t/a! le+

tn%% /ar &ana a/an an% +ar. #A# /an #AK ana! lan !al e+ar3 ta& !aln;a 0 en/o! te+. Setela+ /er!an oat3 &ana a/an ana!teta& tn%%3 $a!a /a:a eroat !e RSRj.

Ana! t/a! &erna+ a!t e&ert n eelu$n;a. Dar !eluar%a $au&un tetan%%a

t/a! a/a ;an% a!t e&ert n $au&un e/an% /e$a$ t+;&o/ /an /e$a$ /en%ue. Dar

!eluarn;a t/a! a/a ;an% $e$&un;a r:a;at aler%.

Riwa2a% K0!ahia$ 4Bi%h His%&25:

Ana! la+r e !al /en%an +/an%an na /an lau!*lau! ;an% er?ara /ala$ ju$la+ e&aru+ /ar

0 8 a % e


3/31

&or oran% /e:aa

9a!anan e!aran%' * Na=u $a!an ' er!uran%

* Vara ' er?ara (na3 !an3 telur)

* Ju$la+ ' 1 &rn% !e


4/31

P0$2a/i% Ya Ti(a/ Hu#u$)a$

Aler% * *

A$a * *

Tuer!olo * *&erten * *

D a e t e * *

Kejan% De$a$ * *

E&le& * *

Si!si!ah K0!ua)a 4Fami!2;s T005

Sisi I#u

62 t+n 61 t+n

Sisi A2ah

64 t+n 22 t+n

>6 t+n >5 t+n >0 t+n >2 t+n >5 t+n >4 t+n 0- t+n

Lela!

ere$&uan 14 t+n - t+n

aen

Riwa2a% S&sia! P0s&$a! 4S&


5/31

era$a a;a+3 u /an !a!a!n;a. Ru$a+ !ontra!an ;an% /&eruat /ar atu


6/31

9ulut

(B) #r ' er/ara+

(B) L/a+ 'strawberry tongue

(*) u

(*) 9u!oa

Ten%%oro!an

(*) N;er ten%%oro!an (*) erua+an uara

Le+er

(*) #enjolan (*) N;er le+er

T+ora (Jantun% aru*&aru)

(*) Sea! na&a

(*) #atu!

(*) N;er /a/a

(*) 9en%

(*) #atu! er/ara+

(*) #er/ear*/ear

A/o$en (La$un%, Uu)

(*) 9ual

(*) Dare

(*) N;er e&%atru$

(*) Tnja er/ara+

(*) #enjolan

(*) 9unta+

(*) Kont&a

(*) N;er !ol!

(*) Tnja er:arna /e$&ul

Saluran !e$+ , Alat !ela$n

(*) Dura (*) e$atura

(*) Enure ($en%o$&ol)

Sara= /an Otot

(*) R:a;at Trau$a (*) N;er (*) #en%!a!

E!tre$ta

6 8 a % e


7/31

(B) #en%!a! (*) De=or$ta

(*) N;er (*) Sano

B0a% Ba(a$

#erat a/an rata*rata ' 01 !% ( *1 ,/ *0)

#erat a/an tertn%% ' 01 !% ( *1 ,/ *0)

#erat a/an e!aran% ' (@) Teta& ( ) Na! ( ) Turun

PEMERIKSAAN FISIK

K0a(aa$ umum : Ta$&a! a!t e/an%3 !ea/aran 7.7 C

A$%&3&m0%i/ : T# ' 104


8/31

Hi(u$) :Nor$oe&ta3$etr3 !anan /an !r t/a! a/a /e?a3 e!eret (B) jern+

Mu!u% ' Stra:err; ton%ue B

T0$))&&/a$ : T1*T1 tenan%3 =arn% t/a! +&ere$

L0h0 : Kelenjar tro/ /an !elenjar %eta+ enn% t/a! teraa $e$ear

Th&a@

Pau+3au

In&e! ' S$etr &a/a tat /an /na$3 retra! /n/n% /a/a (B)

er!u ' Sonor / !e/ua la&an%an &aru

al&a ' Vo!al =re$tu !anan !r $etr

Au!ulta ' Suara na&a ?e!uler3 ron! *,*3 :+eeGn% *,*

Ja$%u$)

In&e! ' I


9/31

A!a% /0!ami$ 4a%as i$(i/asi5: e$er!aan t/a! /la!u!an

>&!&/ (u#u 4a%as i$(i/asi5: e$er!aan t/a! /la!u!an

E@%0mi%as 4!0$)a$ %u$)/ai5:

A!ral +an%at

Tonu' !uat

CRT 0HH

9aa' &e$er!aan t/a! /la!u!an

S0$(i

Ke!uatan' Senor'B2 B2 B B

B2 B2 B B

E/e$a' Sano'

B B * *

B B * *

Lan*lan' A!ral +an%at3 &ttn% e/e$a (B)

P0m0i/saa$ $0u&!&)is 4"i/a (i30!u/a$5:

Tn%!at !ea/aran ' CS 12 (E'539'63V'2)

Delru$ ' T/a! a/a

Orenta te$&at3 :a!tu3 oran% ' #a!

Tre$or3 !orea3 ateto ' T/a! a/a

Ran%an% $enn%eal ' !a!u !u/u!3 !ern%3 ru/Gn!;3 laeue (&e$er!aan t/a! /la!u!an)

Sara= ota! I ' en


10/31

Sara= ota! III ' era! ola $ata/a&at $en%!ut ara+ %era! tan%an (a!)

Sara= ota! IV ' era! ola $ata/a&at $elr! oran% lan (a!)

Sara= ota! V ' Senor /aera+ :aja+raa %el la /%ore le$ut / && (a!)

Sara= ota! VI ' era! ola $ata/a&at $en%!ut ara+ a&a erjalan (a!)

Sara= ota! VII ' Teren;u$3 $enutu& $ata $etr (a!)

Sara= ota! VIII ' en/en%aran$enole+ !e ara+ u a&ala /&an%%l (a!)

Sara= ota! I ' o u?ula&e$er!aan t/a! /la!u!an

Sara= ota! ' e$er!aan t/a! /la!u!an

Sara= ota! I ' e$er!an t/a! /la!u!an

Sara= ota! II ' De?a l/a+&e$er!aan t/a! /la!u!an

Uj Koor/na ' e$er!aan t/a! /la!u!an

P0m0i/saa$ R0=!0/s

R0=!0/s T0$(&$ Ka$a$ Kii

#e& 0B 0B

Tre& 0B 0B

atela 0B 0B

A7-.444,$$>

14 8 a % e


11/31

e$ato!rt ' >7

LED 1 ja$ ' 26

LED 0 ja$ ' 72

tun% jen el ' #ao=l ' 4

Eono=l ' 1

#atan% ' 1

Se%$ent ' 74

L$=ot ' 06

9onot ' 0

) Serolo% '

CR ' B, 1>

) e$er!aan $or=ol% /ara+ te& '

Ertrot ' ta$&a! nor$o!ro$ anoto

Leu!ot ' ju$la+ ta$&a! a%a! $en%!at3 /te$u!an +&er&%$enta /an %ranula to!!

(l%+t) &a/a e%$en neutro=l

Tro$ot ' /te$u!an !elo$&o! tro$ot3 ant tro$ot (B)

Kean ' e/aan +a&u /ara+ te& $enunju!!an %a$aran ertrot nor$o!ro$

anoto3 leu!oto3 /erta a/an;a +&er&%$enta /an %ranula to!! (l%+t) &a/a

e%$en neutro=l

?) Ront%en t+ora! '

Cor3 nu /an /a=ra%$a ' nor$al

ul$o ' +l !aar3 +ar S9RS ' !e/ua $ata $a+ $era+3 %atal3 a/a ele!an3 a!t /an /erta !elu+an ara:an

/ r /an &ana a/an

1 +ar S9RS ' !elu+an $eneta&

11 8 a % e


12/31

#eera&a ja$ S9RS ' !elu+an $eneta&

P0m0i/saa$ Fisi/

Kea/aan u$u$ ' Ta$&a! a!t e/an%3 !ea/aran 0,$ent

S ' >7.7 C

Antro&o$etr! ' T# ' 104


13/31

e$ato!rt ' >7

LED 1 ja$ ' 26

LED 0 ja$ ' 72

tun% jen el ' #ao=l ' 4

Eono=l ' 1

#atan% ' 1

Se%$ent ' 74

L$=ot ' 06

9onot ' 0

) Serolo% '

CR ' B, 1>

) e$er!aan $or=ol% /ara+ te& '

Ertrot ' ta$&a! nor$o!ro$ anoto

Leu!ot ' ju$la+ ta$&a! a%a! $en%!at3 /te$u!an +&er&%$enta /an %ranula to!!

(l%+t) &a/a e%$en neutro=l

Tro$ot ' /te$u!an !elo$&o! tro$ot3 ant tro$ot (B)

Kean ' e/aan +a&u /ara+ te& $enunju!!an %a$aran ertrot nor$o!ro$

anoto3 leu!oto3 /erta a/an;a +&er&%$enta /an %ranula to!! (l%+t) &a/a

e%$en neutro=l

DIAGNOSIS KERJA

Kawasa/i (is0as0

Daar /a%no ' a/ala+ er/aar!an $&to$ /an +al laoratoru$

Ana! n $e$&un;a $&to$ /e$a$3 !e/ua $atan;a $era+3 $ulutn;a !ern%3 &e


14/31

tro$ot.

DIAGNOSIS DIFFERENSIAL

1. De$a$ er/ara+

Daar /a%no ' /e$a$ 5 +ar

0. #ro!o&neu$ona

Daar /a%no ' leu!ot /an LED tn%%

PENATALAKSANAAN:

M0(i/am0$%&sa:

1. A&let >0 ta0. a$$ara ? 50%,10ja$ ela$a 7*14 +ar

>. 9et+;l&re/nolone 6>4$%,05 ja$ ?

5. l;ern ole r 5,+ar

N&$ M0(i/am0$%&sa:

* Total e/ret

E(u/asi:

* Det aa ' tn%% !alor tn%% &roten3 %G len%!a&

* #an;a!!an $nu$ ar &ut+

R0$


15/31

A/ ?ta$ ' ona$

A/ =un%onal ' ona$

A/ anatona$ ' ona$

FOLLOW UP:

Ta$))a! O/% -*, "am -C- WIB

Hai /0+ (iawa%, D0mam hai /0+

S : ana! $a+ teraa a/ann;a &ana3 $ata $a+ teraa a!t /an %atal3 r ju%a

$a+ teraa a!t e+n%%a ua+ $a!an3 $a+ elu$ #A#

O : Kea/aan u$u$ ' Ta$&a! a!t e/an%

Kee/araan ' Co$&o $ent

Te!anan /ara+ ' 144,64 $$%

Na/ ' 116,$ent

Na=a ' >0,$ent

Su+u ' >6.1 oC

Ke&ala ' Nor$oe=al!

9ata ' Conjun%t?t B,B

Jantun% ' #J I " II re%ular3 $ur$ur (*)3 %allo& (*)

aru*&aru ' uara na=a ?e!uler3 ron!+ *,*3 :+eeGn% *,*

A/o$en ' oe&el3 /atar3 ?a!ult B

E!tre$ta ' a!ral +an%at3 CRT 0M3 ?a!ult B

A : Ka:aa! /eae /ala$ &en%oatan

P : IVFD Kaen 9> 1444


16/31

Cerne?t ($ult?ta$n) a$&ul,Fl Kaen 9>

a$$ara 1 Fl,+ar

Staron (> ta,+ar

Ta$))a! C O/% -*, "am -C- WIB

Hai /0+C (iawa%, D0mam hai /0+

S : ana! ult t/ur ta/ $ala$3ana! $a+ teraa a/ann;a &ana3 $ata $a+ teraa

a!t /an %atal3 $ulut /an r $a+ a!t e+n%%a ua+ $a!an3 $a+ elu$ #A#



Te!anan /ara+ ' 144,64 $$%

Na/ ' 110,$ent

Na=a ' 0-,$ent

Su+u ' >6.2 oC

Ke&ala ' Nor$oe=al!






A : Ka:aa! /eae /ala$ &en%oatan



17/31

Cerne?t ($ult?ta$n) a$&ul,Fl Kaen 9>

a$$ara 1 Fl,+ar

Staron (> ta,+ar

l;ern ole r 5,+ar

Ta$))a! . O/% -*, "am -C- WIB

Hai /0+. (iawa%, D0mam hai /0+

S : ana! u/a+ t/a! teraa a/ann;a &ana3 $ata $a+ teraa a!t /an %atal3 r

$ula &e6.- oC

Ke&ala ' Nor$oe=al!






A : Ka:aa! /eae /ala$ &era!an



18/31


19/31

P : IVFD Kaen 9> 1444 ta,+ar

I$oot =orte 11 Ct+,+ar

l;ern ole r 5,+ar

A$no=un ae/ /+ent!an

Ta$))a! O/% -*, "am -C- WIB

Hai /0+ (iawa%, D0mam hai /0+*-

S : ana! u/a+ t/a! teraa a/ann;a &ana3 r $a+ &e7.1 oC

Ke&ala ' Nor$oe=al!

9ata ' Conjun%t?t ,





1 8 a % e


20/31




l;ern ole r 5,+ar

Ta$))a! O/% -*, "am -C- WIB

Hai /0+ (iawa%, D0mam hai /0+*-

S : ana! u/a+ t/a! teraa a/ann;a &ana3 r $a+ teraa !ern%3 $a+ elu$

#A#



Te!anan /ara+ ' 144,74 $$%

Na/ ' 144,$ent

Na=a ' 06,$ent

Su+u ' >7.1 oC

Ke&ala ' Nor$oe=al!

9ata ' Conjun%t?t B,BJantun% ' #J I " II re%ular3 $ur$ur (*)3 %allo& (*)



E!tre$ta ' a!ral +an%at3 CRT 0M

04 8 a % e


21/31


22/31

A : Ka:aa! /eae



l;ern ole r 5,+ar

Ta$))a! O/% -*, "am -C- WIB

Hai /0+ (iawa%, D0mam hai /0+*

S : ana! u/a+ t/a! teraa a/ann;a &ana3 r $a+ !ern%3 $a+ elu$ #A#



Te!anan /ara+ ' 144,64 $$%

Na/ ' 106,$ent

Na=a ' 05,$ent

Su+u ' >6 oC

Ke&ala ' Nor$oe=al!


Jantun% ' #J I " II re%ular3 $ur$ur (*)3 %allo& (*)aru*&aru ' uara na=a ?e!uler3 ron!+ *,*3 :+eeGn% *,*


E!tre$ta ' a!ral +an%at3 CRT 0M

00 8 a % e


23/31




l;ern ole r 5,+ar

Er;ane >1 Ct+,+ar

0> 8 a % e


24/31

EPIDEMIOLOGY

Ka:aa! /eae +a een re&orte/ n all ra


25/31

0Ot+er n?et%ator +a?e =oun/ e?/en2

A %enet< n=luen


26/31

%ro:t+ =a


27/31

nttuton3 an/ $an; http://www.ncbi.nlm.nih.gov/pubmed/8997168http://www.ncbi.nlm.nih.gov/pubmed/9777957http://www.ncbi.nlm.nih.gov/pubmed/7491221http://www.ncbi.nlm.nih.gov/pubmed/9427895http://www.ncbi.nlm.nih.gov/pubmed/2426590http://www.ncbi.nlm.nih.gov/pubmed/9695293http://www.ncbi.nlm.nih.gov/pubmed/12113319http://www.ncbi.nlm.nih.gov/pubmed/15069399http://www.ncbi.nlm.nih.gov/pubmed/1716411


28/31

9nor a/?ere rea


29/31

tll un


30/31

Fig 5

1A4 6n t"e day !5 of Kawasaki disease) a 2D&ec"oca#diog#am demonst#ates an aneu#ysm of

t"e .%A in a si'&yea#&old boy 1/4 %o#ona#y angiog#am #eveals diffuse dilatation in t"e left

ante#io# descending 1.AD4 b#anc" of t"e left co#ona#y a#te#y 1.%A4 in t"e ...

Fig 7

Abdomial ao#tog#am 1A4 and a !D&image of t"e com$uted tomog#am 1/4 s"owing t"e aneu#ysm

of t"e distal abdominal ao#ta) 8ust below t"e o#igin of infe#io# mesente#ic a#te#y 1I9A4 wit" an

involving bifu#cation

9an; tu/e +a?e atte$&te/ to /ent=; &re/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687814/figure/F6/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687814/figure/F5/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687814/figure/F6/http://www.ncbi.nlm.nih.gov/pubmed/10931408http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687814/#B106http://www.ncbi.nlm.nih.gov/pubmed/8822996http://www.ncbi.nlm.nih.gov/pubmed/3802442http://www.ncbi.nlm.nih.gov/pubmed/3423060http://www.ncbi.nlm.nih.gov/pubmed/4061324http://www.ncbi.nlm.nih.gov/pubmed/3802442http://www.ncbi.nlm.nih.gov/pubmed/8822996http://www.ncbi.nlm.nih.gov/pubmed/8822996http://www.ncbi.nlm.nih.gov/pubmed/11737728http://www.ncbi.nlm.nih.gov/pubmed/9310527http://www.ncbi.nlm.nih.gov/pubmed/8822996http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687814/#B114http://www.ncbi.nlm.nih.gov/pubmed/8822996http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687814/#B114http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687814/#B114http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687814/#B114http://www.ncbi.nlm.nih.gov/pubmed/3668739http://www.ncbi.nlm.nih.gov/pubmed/3712157


31/31

et+er t+e le=t $an

Documents

Case Kawasaki Disease Word