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Keluhan utamaDemamm 3 hari ini,bapil, sesak - , mual +, muntah -, BAK jumlah normal warna normal, tapinyeri saat kencing. BAB.mencret saat di RS 1 kali, 2 hr yang lalu mencret dirumah mencret >5 kali sampai lemes, tiap mencret volume

Riwayat penyakit terdahuluHM 1,5 tahun yg lalu dirawat di RS Soewandi + endoscopi di RSDS dg hasil : gastritis erosiva dan ve grade I dx. Liver dan lambungPerut membesar dan mimisan pendarahan bawah kulit -

Pemeriksaan FisikKU: lemah, gcs: 456Tensi: 110/80 mmHg, Nadi: 80 kali/menitRR:k/L: a/i/c/d = -/ +/-/-Th: vesiculer Rh -/- Wh -/- C. S1s2 tunggal ST-Abd: distended, ascites +, vena kolateral-Ext. Pitting oedema di kaki

HematologySoewandi RS IRD09/02/15GDC12/02/15GDC14/02/15WBC (103/uL)13.511.6113.72.901% Eo0.30.23.83.4% Ba0.20.362.00.5210% Neu83.282.479.766.17% Ly9.910.723.517.75% Mo6.45.010.412.16RBC (106/uL)3.663.492.852.865HGB (g/dL)12.211.39.69,769Hct (%)-34.228.528.82MCV (fL)36.197.8100.0100.6MCH (pg)-32.433.734.9MCHC (g/dL)-33.233.733.9RDW (%)-17.216,715.94PLT (103/uL)38292120.33MPV (fL)-9.8-11.34

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Blood Smear Evaluation (09/02/2015)E:Part of population normochromic, part of population hypochromic, anisopoikilocytosis (normocytes, macrocytes, fragmentocytes, burr cells, target cells), polychromatophilic cells (-), normoblast (-)L:Seems to be normalin number, dominated by segmented neutrophil, hypersegmented neutrophil(-),blast -. IG -T:Seems to be decrease in number, giant platelet (-)Conclusion : normochromic anemia. trombositopenia

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Clinical ChemistrySoewandi 1/11IRD09/02GDC12/02GDC15/02BUN mg/dL1010Sc mg/dL0.841.0Albumin g/dL2.331.92.4Total protein/dL5.79D. Bil mg/dL2.521.39T. Bil mg/dL7.712.87AST U/L948542ALT U/L735647RBG mg/dL97156

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Clinical Chemistry IRD9/02/15GDC12/02/15Na135135K4.33.4Cl110110CaPO4

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Coagulation studyIRD 9/02/15GDC12/02/15PPT 18.5 s15.7 sAPTT40.6 s42.4 s

ImmunologyHBsAg rapid test (IRD)NegatifAnti HCVReactive

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12BGAIRD9/02/15pH7.516pCO222.7pO2101.4HCO318.5TCO219.2BE-ecf-4.6SaO298.6AaDo219.9Temp36.9

URINALYSIS ( IRD, 09/02/2015 )SG : 1.015Color : yellowpH : 6.5Clarity : clearLeu : 2+Blood : 3+SEDIMENT

Nitrit : (+)Ery : 25-50Protein :1+ Leu : 20-30Glucose : negativeEpithel : fewKeton : (1+)Cast : (-)Bilirubin: 1+Crystal : (-)

Chest X-Ray (09/02/15)Normal 14

Dx : Cirrhosis Hepatic Child C + UTI + Sepsis Tx : Diet H2 2100 kcal/dayInfus PZ : Comafusin = 1 : 1Inj. Omeprazole 2x1 ivInj. Cyprofoxacine 2x1 g ivInf. Albumin 20% 100 cc/6 hrInf. Vitamin K 1x 1 ampSucralfat 3 x 1Tranfusi FFP 3 kolf in one hour15

dx. SH Child B+isk+sepsis+FH panjang

Pemeriksaan laboratorium

HDT

BilirubinACCURATE RESULTS IN THE CLINICAL LABORATORY (122-124)Main causes of hyperbilirubinemia include thefollowing:1. Defects in conjugation, including severe liver insufficiency, genetic defects in UGT1A1 (CriglerNajjar and Gilbert syndromes), and inhibition of UGT1A1, leading to increased blood unconjugated bilirubin levels2. Increased heme catabolismfor example, associated with severe hemolysisleading to elevated blood levels of unconjugated bilirubin3. Defects in biliary excretion (cholestasis), caused by diseases interfering with liver or biliary architecture, which cause increases predominantly in conjugated bilirubinemia

Ikterik kerap nampak jika kadar bilirubin mencapai > 3 mg/dl. Kenikterus timbul karena bilirubin yang berkelebihan larut dalam lipid ganglia basalisFrances K. Widmann, alih bahasa : S. Boedina Kresno, dkk.,Tinjauan Klinis Atas Hasil Pemeriksaan Laboratorium, EGC, Jakarta, 1992.