STATUS ILMU BEDAH RUMAH SAKIT ANGKATAN LAUT DR. MINTOHARJO BENDUNGAN HILIR, JAKARTA PUSAT
Nama penyusun
: Mo!ama" Sa#$%o &a%'
NIM
: ()(.*(.*+(
Pem%m%n-
: D$. An"anu In"$a#no#o Sp.B. K/ BD
I.
IDENTITAS PASIEN
Nama Jen%s Ke0am%n Us%a A0ama# Pen"%"%2am Pe2e$4aan
: Ma%s%e E0%sa, an. : Pe$empuan : 1 #a!un 1 u0an : J0. Lau# Ma0u2u N(.* RT (*3** 2omp0e2 SESKOAL : SD : Aya! Aya! : Pe$5%$a TNI6AL Iu : IRT Ruan- Pe$a5a#an Pe$a5a#an : P. P. Sea#%2 Sea#%2 Tan--a0 --a0 Masu Masu2 2
: *7 *73** 3**37(* 37(*8 8
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II. ANAMNESIS Anamnes%s "%0a2u2an sea$a a00oanamnes%s #e$!a"ap %u pas%en "% $uan- 7 an-sa0
P. Sea#%2 pa"a #an--a0 *)3**37(*8. *. Ke0u!an u#ama Pas%en "a#an- "en-an 2e0u!an "emam #%n--% se4a2 *( 4am SMRS. 7. Ke0u!an #ama!an Pas%en men-e0u! nye$% pe$u# 2anan a5a! *( 4am SMRS. ). R%5aya# penya2%# se2a$an- RPS/ Nye$% yan- "%$asa2an pas%en e$0an-sun- se4a2 2u$an-60e%! *( 4am 4 am SMRS, nye$% n ye$% #a4am #a4am "an #e$0o2a #e$0o2a0%sa 0%sas% s% pa"a pa"a "ae$a! "ae$a! 2anan 2anan a5a! a5a! pe$u#. pe$u#. 7 u0an u0an see0um see0umnya nya,, pas%en pas%en men-a0am% nye$% yan- "%a2u% #%"a2 #e$0o2a0%sas% 2e !anya sa#u a-%an pe$u# #e$#en#u, nye$% #e$seu# #e$seu# "%a2u% "%a2u% #e$asa 0e%! $%n-an "%an"%n-2 "%an"%n-2an an nye$% saa# see0um see0um masu2 $uma! sa2%#. Nye$% #e$seu# !%0an- saa# pas%en "%e$% oa# sanmo0 o0e! %unya. Pas%en 4u-a men"e$%#a "%a$e 7 u0an yan- 0a0u, munu0 "%5a2#u yan- sama saa# #e$4a"% nye$% pe$u#, "en-an 9$e2uens% BAB 76)3!a$% "en-an 2ons%s#ens% a%$. D%a$e %n% "%a2u% o0e! %unya, !%0an- "en-an sen"%$%nya. 7 m%n--u SMRS, pas%en men-a0am% "emam #%n--%, "emam #e$seu# "%a2u% #e$asa e$2e0an4u#an. Iu pas%en 2emu"%an mema5a pas%en e$oa# 2e "o2#e$ ana2 "% %ns#%#us% 2ese!a#an #e$"e2a#nya, "an 2emu"%an "%e$%2an oa# penu$un "emam "an an#%%o#%2 a%$ o0e! "o2#e$ #e$seu#. Ge4a0a6-e4a0a %n% 2emu"%an #%"a2 #e$4a"% !%n--a men4e0an- pas%en masu2 2e $uma! sa2%#. Se2%#a$ pu2u0 ().(( pa-% pa"a #an--a0 *7 No;eme$ 7(*8 a#au se2%#a$ *( 4am SMRS. SMRS. Pas%en Pas%en men-a0a men-a0am% m% "emam "emam #%n--% #%n--%.. Pas%en Pas%en 2emu"% 2emu"%an an "%a5a "%a5a 2e Sa#2es Sa#2es TNI #e$"e2a# "an 2emu"%an "%pe$%2sa o0e! "o2#e$ Sa#2es. Iu pas%en men"es2$%ps%2an a!5a pas%en me$asa2an sa2%# 2e#%2a "o2#e$ mene2an a-%an 2anan a5a! pas%en "an 4u-a
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2e#%2a "o2#e$ mene2u2 2a2% 2anan pas%en. O0e! "o2#e$ pus2esmas, pas%en 2emu"%an "%$u4u2 2e RSAL M%n#o!a$4o "an "%pu#us2an un#u2 men4a0an% ope$as% s e-e$a. <. R%5aya# penya2%# "a!u0u RPD/ Iu pas%en men-a2u% a!5a pas%en #%"a2 pe$na! men"e$%#a penya2%# yanmemua#nya "%$a5a#%nap2an "%$uma! sa2%# see0umnya. Penya2%# yan- "%"e$%#a, "%a2u% !anya sea#as "emam "an 90u $%n-an. 8. R%5aya# a0e$-% RA/ Pas%en "%a2u% #%"a2 mem%0%2% a0e$-%, a%2 a0e$-% ma2anan, "eu, su!u, maupun oa#. Pas%en #%"a2 mem%0%2% asma, #%"a2 a"a an--o#a 2e0ua$-a yan- men"e$%#a asma. 1. R%5aya# 2e!am%0an RH/ R%5aya# %u saa# !am%0 "en-an pas%en "%a2u% a%2. San- %u #%"a2 men"e$%#a penya2%# #e$#en#u 2e#%2a men-an"un- pas%en. Den-an 4a"5a0 2un4un-an 2on#$o0 2e!am%0an yan#e$a#u$. =. R%5aya# 2e0a!%$an RL/ Pas%en "%0a!%$2an "en-an se#%o aesa$%a "% RS Ma$%n%$ >%0an"a2, #anpa 2omp0%2as%. Be$a# a"an 0a!%$ no$ma0, menan-%s spon#an. +. R%5aya# %mun%sas% RI/ D%a2u% %unya a!5a pas%en #e0a! men4a0an% %mun%sas%, a"apun 4en%s %mun%sas% yan"%e$%2an #%"a2 "%2e#a!u% pas#% 2a$ena 2e#e$a#asan pen-e#a!uan "an %n-a#an na$asume$. ?. R%5aya# penya2%# 2e0ua$-a RPK/
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Aya! "an %u pas%en "%a2u% mem%0%2% #e2anan "a$a! #%n--%. Aya! pas%en pe$na! men"e$%#a ;a$%oe0e.
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III. PEMERIKSAAN FISIK (12/11/2015 & 13/11/2015)
Kea"aan u mum 6 6 6
Kesa"a$an Kesan sa2%# Kesan -%'%
: Compos mentis : Tampa2 sa2%# se"an: G%'% u2up
Tan"a6#an"a ;%#a0 : 6 6 6 6 6
TD : *7(3+( mmHN : **( 3men%# $e-u0e$/ RR : <7 3men%# S : )+.( o> An#$opome#$% : BB : 78 2-, TB : 18 m
Status Genera!s "
KULIT @a$na 2u0%# sa5o ma#an-, pua# 6/, s%anos%s 6/, %2#e$%2 6/, #u$-o$ 2u0%# a%2 KEPALA No$mo!epa0%, "e9o$m%#as 6/, $amu# : !%#am, "%s#$%us% me$a#a, #%"a2 mu"a! "%au#. Ma#a : on4un-#%;a anem%s (#/#)$ s20e$a %2#e$%2 636/, pup%0 %so2o$, p#os%s 6/, pa0pe$a oe"em 6/. Te0%n-a : No$mo#%a H%"un- : De9o$m%#as 6/, Mu0u# : s%anos%s 6/, %%$ "an mu2osa mu0u# #%"a2 2e$%n-, LEHER Inspe2s% : KGB "an 2e0en4a$ #%$o%" #%"a2 #ampa2 memesa$
THORAKS
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Inspe2s% : T%"a2 #ampa2 e90o$esens% yan- e$ma2na, -e$a2 pe$na9asan s%me#$%s, #%"a2 #ampa2 pe$-e$a2an na9as yan- #e$#%n--a0, #u0an- %-a #%"a2 #e$0a0u ;e$#%2a0 maupun !o$%'on#a0, $e#$a2s% o#o#6o#o# pe$napasan 6/. Aus2u0#as% : 6 6
Jan#un- : Buny% 4an#un- I II $e-u0a$, mu$mu$ 6/ -a00op 6/. Pa$u : Sua$a napas ;es%2u0e$ 3/, 5!ee'%n- 636/, Ron2% 636/.
ABDOMEN Inspe2s% : T%"a2 #ampa2 e90o$esens% yan- e$ma2na. EKSTREMITAS Inspe2s% : S%me#$%s, #%"a2 #ampa2 e90o$esens% yan- e$ma2na, oe"em 6/ pa"a 2eempa# e2s#$em%#as. Pa0pas% : A2$a0 #e$aa !an-a#. Status %a!s
S#a#us 0o2a0%s pa"a 2ua"$an 2anan a5a! a"omen Loo2: "n &ee0: McBurney’s sign /, rebound tenderness / Mo;e: Obturator sign /, psoas sign /
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I'. PEMERIKSAAN PENNANG Pe*er!saan a+%rat%r!u* (12/11/15)
• • • • •
H H# Leu2os%# LED T$omos%#
H%#un- Jen%s
: *8,* -3"0 No$ma0: *76*1 -3"0/ : << ;o0 C No$ma0 : )=6<) ;o0 C/ : *).8((3mm) No$ma0 : 8.(((6*(.(((3mm )/ : 87 mm34amNo$ma0 : )+ mm34am/ : 77=.(((3mm ) No$ma0 :7((.(((68((.(((3mm )/
:
Baso9%0
: ( C (6* C/
Eos%no9%0
: ( C *6) C/
Ba#an-
: * C 761 C/
Se-men
: ?( C 8(6=(C/
L%m9os%#
: *8 C 7(6<( C/
Monos%#
: < C 76+ C/
'. RINGKASAN
Pas%en "a#an- "en-an 2e0u!an "emam #%n--% se4a2 *( 4am SMRS "an men-e0u! nye$% pe$u# 2anan a5a! *( 4am SMRS. Nye$% #a4am "an #e$0o2a0%sas% pa"a "ae$a! 2anan a5a! pe$u#. Pas%en 4u-a men-a0am% "emam #%n--%, "emam #e$seu# "%a2u% #e$asa e$2e0an4u#an. Pas%en me$asa2an sa2%# 2e#%2a "o2#e$ mene2an a-%an 2anan a5a! pas%en "an 4u-a 2e#%2a "o2#e$ mene2u2 2a2% 2anan pas%en. Pa"a peme$%2saan 9%s%2 "%#emu2an pen%n-2a#an su!u, MBu$neys s%-n /, $eoun" #en"e$ness /, o#u$a#o$ s%-n /, "an psoas s%-n /. Pa"a peme$%2saan 0ao$a#o$%um "%#emu2an 0eu2os%#os%s, pen%n-2a#an LED "an shift to the right pa"a !%#un- 4en%s 0eu2os%#. 'I. DAFTAR MASA,A-
•
Appen"%%#%s 2$on%2 e2sase$as% a2u# 7
'II. ANA,ISA MASA,A-
Pa"a pas%en %n%, masa0a! "%#e-a22an e$"asa$2an !as%0 anamnes%s ya2n% nye$% e$u0an- se4a2 7 u0an SMRS, "a$% po0a "%9us, 2emu"%an e$m%-$as% 2e 2anan a5a! pe$u#F "%se$#a% "en-an -an--uan pene$naan e$upa "%a$e "en-an 9$e2uens% 76) se!a$% "en-an 2ons%s#ens% a%$. Pas%en 4u-a men-a0am% "emam yan- u2up #%n--% yan- 4u-a e$u0an- se4a2 7 m%n--u SMRS "en-an po0a e$2e0an4u#an pa"a saa# "emam. Ke#%-a -e4a0a #e$seu# 2emu"%an 2ema0% e$u0an- "en-an %n#ens%#as yan- 0e%! #%n--% yan- memua# pas%en "%a5a 2e $uma! sa2%#. Se0a%n %#u, pa"a peme$%2saan 9%s%2 "%#emu2an 2ena%2an su!u, "an pa"a peme$%2saan 0o2a0 2ua"$an 2anan a5a! a"omen "%#emu2an #an"a MBu$ney /, #an"a o#u$a#o$ /, #an"a psoas / "an $eoun" #en"e$ness /. Tan"a6#an"a #e$seu# %n"%2a#%9 #e$!a"ap masa0a! yan- "%a0am% pas%en. Pa"a peme$%2saan 0ao$a#o$%um 4u-a "%"apa#2an a"anya 0eu2os%#os%s, LED yanmen%n-2a# "an a"anya pe$-ese$an p$o"u2s% ne#$o9%0 2e 2anan, menan"a2an %n90amas% yan#e$4a"% me$upa2an %n90amas% 2$on%2. Ha0 %n% 4u-a men"u2un- #e$!a"ap masa0a! yan- "%a0am% pas%en.
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'III. PENATA,AKSANAAN
Pena#a0a2sanaan yan- "%0a2u2an pa"a pas%en %n% a"a0a! open appendectomy %#o pa"a #an--a0 *73**37(*8 pu2u0 *<.)(. Ha0 %n% "%0a2u2an a#as pe$#%man-an nye$% yan- e$u0an"an pas%en #e$0%!a# 2esa2%#an se!%n--a "%u#u!2an relieve a#as $asa sa2%#nya se-e$a. Pre#%erat!
Pas%en pa"a saa# p$e6ope$as% #e$0%!a# san-a# -e0%sa!, #e$"en-a$ men4e$%# "an menan-%s. Ha0 %n% 2emun-2%nan "%2a$ena2an $asa sa2%# yan- "%a0am% pas%en "an 4u-a $asa #a2u# yan"%a0am% pas%en a2%a# 2on"%s% $uan- ope$as%. T%pe anes#es%a yan- "%0a2u2an a"a0a! anes#es% umum. Durante %eras!
Se#e0a! pas%en e$a"a "a0am 2ea"aan anes#es%a, ope$a#o$ "$. Mo'a$# Sp. B/ me0a2u2an ope$as% open appen"e#omy "en-an %ns%s% MBu$ney6MA$#!u$ pa"a 2ua"$an 2anan a5a! a"omen 2u$an- 0e%! 8 m. Se#e0a! %#u "%0a2u2an %ns%s% #e$!a"ap 9as%a >ampe$ "an 9as%a Sa$pa un#u2 "apa# mem%sa!2an m. oblique externus "en-an 20em "an $e#$a2#o$. Se#e0a! %#u "%0a2u2an pen--un#%n-an #e$!a"ap pe$%#oneum "en-an a$a! 2$an%o62au"a0 se!%n--a $on--a pe$u# "apa# "%apa%. Se#e0a! appen"%2s #e$%"en#%9%2as%, appen"%2s e$sama "en-an mesoappen"%2s 2emu"%an "%an-2a# 2e "ae$a! %ns%s%, 2emu"%an "%0a2u2an 0%-as% #e$!a"ap a$#e$% appen"%2s "an 2emu"%an appen"%2s "%p%sa!2an "a$% mesoappen"%2s. Se#e0a! %#u, "%0a2u2an 0%-as% -an"a pa"a as%s appen"%2s 2emu"%an appen"%2s "% 20em un#u2 2emu"%an "%po#on-.
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P%st#%erat!
Ins#$u2s% pos#6ope$a#%9 yan- "%e$%2an pa"a pas%en %n% a"a0a! s:
• • • • •
Puasa !%n--a BU / no$ma0 In9us% RL*8 #pm In4e2s% e9o#a%m 78(( mIn4e2s% 2e#o$o0a )*37 amp Pe$a5a#an 0u2a ) !a
%$I. PRGNSIS
A" ;%#am A" sana#%onam A" 9un#%onam
: onam : onam : onam
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TINAAN PSTAKA
Anat%*!
Apen"%2s me$upa2an o$-an e$en#u2 #aun-, pan4an-nya 2%$a62%$a *(m 2%sa$an )6 *8m/, "an e$pan-2a0 "% aeum. Lumennya semp%# "% a-%an p$o2s%ma0 "an me0ea$ "% a-%an "%s#a0. Namun "em%2%an, pa"a ay%, apen"%2s e$en#u2 2e$uu#, 0ea$ pa"a pan-2a0nya "an menyemp%# 2e a$a! u4un-nya. Kea"aan %n% mun-2%n men4a"% sea $en"a!nya %ns%"en appen"%%#%s pa"a us%a %#u. Pa"a 18C 2asus, apen"%2s #e$0e#a2 %n#$ape$%#onea0. Ke"u"u2an %#u memun-2%n2an apen"%2s e$-e$a2 "an $uan- -e$a2nya e$-an#un- pa"a pan4an- mesoapen"%2s pen--an#un-nya.
Gama$ *: ana#om% appen"%2s
Pa"a 2asus se0e%!nya, apen"%2s #e$0e#a2 $e#$ope$%#onea0, ya%#u "% e0a2an- aeum, "% e0a2an- o0on asen"ens, a#au "% #ep% 0a#e$a0 o0on asen"ens. Ge4a0a 20%n%s appen"%%#%s "%#en#u2an o0e! 0e#a2 apen"%2s. Pe$sa$a9an pa$as%mpa#%s e$asa0 "a$% aan- n.;a-us yan- men-%2u#% a.mesen#e$%a supe$%o$ "an a.apen"%2u0a$%s, se"an-2an pe$sa$a9an s%mpa#%s e$asa0 "a$% n.#o$a2a0%s . O0e! 2a$ena %#u, nye$% ;%se$a0 pa"a appen"%%#%s e$mu0a "% se2%#a$ um%0%us. Pen"a$a!an apen"%2s e$asa0 "a$% a.apen"%2u0a$%s yan- me$upa2an a$#e$% #anpa 2o0a#e$a0. J%2a a$#e$% %n% #e$suma#, m%sa0nya 2a$ena #!$omos%s pa"a %n9e2s% apen"%2s a2an men-a0am% -an-$en.
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2.2 F!s!%%!
Apen"%2s men-!as%02an 0en"e$ *67m0 pe$ !a$%. Len"%$ %#u no$ma0nya "%u$a!2an 2e "a0am 0umen "an se0an4u#nya men-a0%$ 2e aeum. Hama#an a0%$an 0en"e$ "% mua$a apen"%2s #ampa2nya e$pe$an pa"a pa#!o-enes%s appen"%%#%s. Immuno-0ou0%n se2$e#oa$ yan- "%!as%02an o0e! GALT -u# asso%a#e" 0ymp!o%" #%ssue/ yan- #e$"apa# "% sepan4an- sa0u$an e$na #e$masu2 apen"%2s, %a0a! I-A. Immuno-0ou0%n %#u san-a# e9e2#%9 sea-a% pe0%n"un- #e$!a"ap %n9e2s%. Namun "em%2%an, pen-an-2a#an apen"%2s #%"a2 mempen-a$u!% s%s#em %mun #uu! 2a$ena 42um0a! 4a$%n-an 0%m9 "%s%n% 2e%0 se2a0% 4%2a "%an"%n-2an "en-an 4um0a!nya "% sa0u$an e$na "an "% se0u$u! #uu!.
Ins!ens!
Te$"apa# se2%#a$ 78(.((( 2asus appen"%%#%s yan- #e$4a"% "% Ame$%2a Se$%2a# se#%ap #a!unnya "an #e$u#ama #e$4a"% pa"a ana2 us%a 16*( #a!un. Appen"%%#%s 0e%! anya2 #e$4a"% pa"a 0a2%60a2% "%an"%n-2an pe$empuan "en-an pe$an"%n-an ):7. Ban-sa >auas%a 0e%! se$%n- #e$2ena "%an"%n-2an "en-an 2e0ompo2 $as 0a%nnya. Appen"%%#%s a2u# 0e%! se$%n#e$4a"% se0ama mus%m panas. Ins%"ens% Appen"%%#%s au#a "% ne-a$a ma4u 0e%! #%n--% "a$%pa"a "% ne-a$a e$2eman-, #e#ap% ee$apa #a!un #e$a2!%$ an-2a 2e4a"%annya menu$un sea$a e$ma2na. Ha0 %n% "%sea2an o0e! men%n-2a#nya pen--unaan ma2anan e$se$a# "a0am menu se!a$%6 !a$%. Appen"%%#%s "apa# "%#emu2an pa"a semua umu$, !anya pa"a ana2 2u$an- "a$% sa#u #a!un 4a$an- "%0apo$2an. Ins%"ens% #e$#%n--% pa"a 2e0ompo2 umu$ 7(6)( #a!un, se#e0a! %#u menu$un. Ins%"ens% pa"a 0a2%60a2% "an pe$empuan umumnya sean"%n-, 2eua0% pa"a umu$ 7(6)( #a!un, %ns%"ens% 0e0a2% 0e%! #%n--%.
Et!%%!
Appen"%%#%s "%sea2an 2a$ena a"anya os#$u2s% pa"a 0umen appen"% se!%n--a #e$4a"% 2on-se#% ;as2u0e$, %s2em%2 ne2$os%s "an a2%a#nya #e$4a"% %n9e2s%. Appen"%%#%s umumnya #e$4a"% 2a$ena %n9e2s% a2#e$%. Penyea os#$u2s% yan- pa0%n- se$%n- a"a0a! 9eo0%#!. &eo0%#! "%#emu2an pa"a se2%#a$ 7(C ana2 "en-an appen"%%#%s. Penyea 0a%n "a$% os#$u2s% appen"%2s me0%pu#%: *. H%pe$p0as%a 9o0%2e0 0ymp!o%" 7. >a$%no%" a#au #umo$ 0a%nnya
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). Ben"a as%n- p%n, %4%6%4%an/ <. Ka"an- pa$as%# Penyea 0a%n yan- "%"u-a men%mu02an Appen"%%#%s a"a0a! u0se$as% mu2osa appen"% o0e! pa$as%# E. histolytica. Be$a-a% spes%es a2#e$% yan- "apa# "%%so0as% pa"a pas%en appen"%%#%s ya%#u: Ba2#e$% ae$o 9a2u0#a#%9
Ba2#e$% anae$o
•
Es!e$%!%a o0%
•
Ba#e$o%"es 9$a-%0%s
•
%$%"ans s#$ep#oo%
•
Pep#os#$ep#oous m%$os
•
Pseu"omonas ae$u-%nosa
•
B%0op!%0a spe%es
•
En#e$oous
•
La#oa%00us spe%es
Pat%enes!s
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19
Pa"a -as#$oen#e$%#%s, "%"apa#2an -e4a0a6-e4a0a yan- m%$%p "en-an appen"%%#%s, #e#ap% #%"a2 "%4umpa% a"anya 0eu2os%#os%s. Kons#%pas%, me$upa2an sa0a! sa#u penyea nye$% a"omen pa"a ana26ana2, #e#ap% #%"a2 "%#emu2an a"anya "emam. In9a$2 omen#um 4u-a "apa# "%4umpa% pa"a ana26ana2 "an -e4a0a6-e4a0anya "apa# menye$upa% appen"%%#%s. Pa"a %n9a$2 omen#um, "apa# #e$$aa massa pa"a a"omen "an nye$%nya #%"a2 e$p%n"a! Pa"a p$%a "e5asa mu"a D%a-nos%s an"%n- yan- se$%n- pa"a p$%a "e5asa mu"a a"a0a! Crohn’s disease, 20%#%s u0se$a#%;a, "an ep%"%"%m%#%s. Peme$%2saan 9%s%2 pa"a s2$o#um "apa# meman#u meny%n-2%$2an "%a-nos%s ep%"%"%m%#%s. Pa"a ep%"%"%m%#%s, pas%en me$asa sa2%# pa"a s2$o#umnya. Pa"a 5an%#a us%a mu"a D%a-nos%s an"%n- appen"%%#%s pa"a 5an%#a us%a mu"a 0e%! anya2 e$!uun-an "en-an 2on"%s%62on"%s% -%ne2o0o-%2, sepe$#% pelvic inflammatory disease !"#$%, 2%s#a o;a$%um, "an %n9e2s% sa0u$an 2en%n-. Pa"a PID, nye$%nya %0a#e$a0 "an "%$asa2an pa"a a"omen a5a!. Pa"a 2%s#a o;a$%um, nye$% "apa# "%$asa2an %0a #e$4a"% $up#u$ a#aupun #o$s%. Pa"a us%a 0an4u# Appen"%%#%s pa"a us%a 0an4u# se$%n- su2a$ un#u2 "%"%a-nos%s. D%a-nos%s an"%n- yanse$%n- #e$4a"% pa"a 2e0ompo2 us%a %n% a"a0a! 2e-anasan "a$% #$a2#us -as#$o%n#es#%na0 "an sa0u$an $ep$o"u2s%, "%;e$#%2u0%#%s, pe$9o$as% u02us, "an 2o0es%s#%#%s. Ke-anasan "apa# #e$0%!a# pa"a >T San "an -e4a0anya munu0 0e%! 0ama# "a$%pa"a appen"%%#%s. Pa"a o$an- #ua, "%;e$#%2u0%#%s se$%n- su2a$ un#u2 "%e"a2an "en-an appen"%%#%s, 2a$ena 0o2as%nya yan e$a"a pa"a a"omen 2anan. Pe$9o$as% u02us "apa# "%2e#a!u% "a$% onse#nya yan- a2u# "an nye$%nya #%"a2 e$p%n"a!. Pa"a o$an- #ua, peme$%2saan "en-an >T San 0e%! e$a$#% "%an"%n-2an "en-an peme$%2saan 0ao$a#o$%um.
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