BAB II PEMBAHASAN 2.1 SKENARIO E

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1 BAB II PEMBAHASAN 2.1 SKENARIO E Mrs. Tari, 37 years old, from middle income family comes to doctor at a public health centre with chief complain of vaginal bleeding. She experienced post coital bleeding for 1 month. Since 1 years ago she has been complaining about vaginal discharge with smelly odor and sometimes accompanied by vulvar itchy. She already has 2 children before and the youngest child is 6 years old. Her husband is a truck driver. She has never gone to doctor related to her complain about vaginal discharge, not using any medication, no history of paps smear examination, and no history of HPV vaccination. She has a history of using intrauterine device (IUD) as contraception for 5 years since her youngest child birth and the IUD has been removed 1 year ago. Her older sister died two years ago caused by breast cancer. You act as the doctor in public health centre and be pleased to analyse this case. In the examination findings: Height: 155 cm, weight: 50 kg, Blood pressure 120/80 mmhg, pulse: 80x/m, RR: 20x/m Palpebral conjunctiva: anemic Breast: there was no mass on both mammae Abdomen: flat and soufflé, symmetric, uterine fundus is not palpable, there are no mass, no painful tenderness and no free fluid sign. Internal Examination: Inspection: vulva and urethra was normal, there was no mass on the vulva, urethra, hymen and perineum Speculum examination: mass on the portio size 2x2 cm, exophytic, fragile, easy to bleed, no infiltration to the vagina, flour + Bimanual examination: cervix is soft, the external os is closed, no cervical motion tenderness, exophytic mass size 2x2x1 cm, fragile, easy to bleed, no infiltration to the vagina, uterine size is normal, both adnexa and parametrium are within normal limit.

2 Then you performed VIA, the result was you could define the external os, squamocollumnar junction and there was thick acetowhite epithelium at the 2 o clock until 5 o clock position, so you performed biopsy. Laboratory result: Hb 8,3 g/dl; WBC /mm3; Thrombocite /mm3; ESR 30 mm/hour. The Next week, the patient come with histopathology result squamous cell carcinoma, moderate differentiation, without limphovascular space invasion. You gave the informed consent to the patient and family to refer her to the hospital, she asked you the diagnosis, kind of examination that will be performed to her, and the possible treatment.

3 2.2 Paparan I. Klarifikasi Istilah No. Istilah Pengertian 1 Perdarahan pervaginam 2 Pendarahan postcoital 3 Vaginal discharge berbau busuk 4 Pemeriksaan paps smear Keluarnya darah dari liang vagina Keluarnya darah dari liang vagina setelah berhubungan seksual dan paling banyak disebabkan karena dysplasia serviks dan kanker serviks Keluarnya lendir dengan berbau busuk Pemeriksaan usapan mulut Rahim untuk melihat sel sel serviks dibawah mikroskop. Pap smear merupakan tes screening untuk mendeteksi dini kanker serviks 5 IUD Sebuah alat kontrasepsi berupa kumparan kecil yang dimasukkan ke 6 Vaksinasi HPV dalam rahim untuk mencegah kehamilan 7 Breast cancer Kanker pada payudara 8 Exophytic Tumbuh kearah permukaan luar, istilah menunjukan proliferasi pada epitel permukaan atau bagian luar organ atau struktur lainnya tempat pertumbuhan itu berasal 9 Tes VIA Pemeriksaan screening kanker serviks dengan cara inspkesi visual 10 Acetowhite epithelium 11 Squamous cell carcinoma pada serviks dengan pemberian asam asetat Suatu proliferasi ganas dari keratinosit epidermis yang merupakan tipe sel epidermis yang paling banyak dan merupakan salah satu kanker kulit yang paling sering dijumpai setelah basalioma 12 Vulvar itchy Gatal pada daerah vulva 13 contraception Pengaturan kelahiran II. Identifikasi masalah Identifikasi Keluhan utama Vaginal bleeding

4 Keluhan tambahan Post coital bleeding for 1 month Riwayat perjalanan penyakit Riwayat social ekonomi Riwayat kehamilan Vaginal discharge for 1 year, sometimes accompanied by vulvar itchy Middle income family, husband is a truck driver P2A0 Riwayat penggunaan kontrasepsi Riwayat keluarga Pemeriksaan fisik Pemeriksaan dalam Pemeriksaan laboratorium Penggunaan kontrasepsi IUD 5 tahun yang lalu dan dilepas 1 tahun yang lalu kakak perempuan meninggal 2 tahun yang lalu karena kanker payudara Height : 155 cm, weight: 50 kg, Blood pressure 120/80 mmhg, pulse: 80x/m, RR: 20x/m Palpebral conjunctiva: anemic Breast: there was no mass on both mammae Abdomen: flat and soufflé, symmetric, uterine fundus is not palpable, there are no mass, no painful tenderness and no free fluid sign. Inspection: vulva and urethra was normal, there was no mass on the vulva, urethra, hymen and perineum Speculum examination: mass on the portio size 2x2 cm, exophytic, fragile, easy to bleed, no infiltration to the vagina, flour + Bimanual examination: cervix is soft, the external os is closed, no cervical motion tenderness, exophytic mass size 2x2x1 cm, fragile, easy to bleed, no infiltration to the vagina, uterine size is normal, both adnexa and parametrium are within normal limit. Hb 8,3 g/dl; WBC /mm3; Thrombocite /mm3; ESR 30 mm/hour.

5 Riwayat pencegahan dan pengobatan Riwayat tindakan Tidak pernah pap smear, vaksin HPV, dan konsumsi obat-obatan. Dilakukan pemeriksaan VIA, dengan hasil terlihat os eksternal squamous collumnair junction dan epitel acetowhite pada pukul 2 sampai 5. Kemudian dilakukan biopsi